LADA diabetes is latent autoimmune diabetes in adults, it is a particular form of diabetes, which has also been described as type 1.5 diabetes.
This type of diabetes usually occurs, as its name suggests, in adults over the age of 35. It is a form of type 1 diabetes but with special features.
Although it has the autoimmune component that triggers type 1 diabetes, the onset of LADA diabetes is a slow and insidious one that can last for many years. Therefore, LADA type diabetes has positive antibodies just like type 1 diabetes, but the destruction of beta-pancreatic cells is much slower and so the patient still has some reserves of cells that produce insulin. In the case of type 1 diabetes, beta-pancreatic cells are destroyed quickly and no more insulin is produced, at which point we must bring insulin from the outside for the patient to survive.
In the case of LADA diabetes, the destruction of beta-pancreatic cells is slower, during a couple of years, so at the onset of the disease patients can be controlled only with diet and oral antidiabetics. Following that in time, after years of evolution, after all beta-pancreatic cells have been destroyed, insulin treatment will be needed.
The characteristics of patients with LADA diabetes
They are similar to those of patients with type 2 diabetes, but often the patient is not obese and is normal weight. What is different from type 1 diabetes is that the onset of LADA diabetes is over the age of 30, while in the case of type 1 diabetes, the onset is usually at an early age, in childhood or at the age of young adult, around the age of 20.
Another difference between type 1 diabetes and LADA diabetes is the way it starts, in the case of the first onset it is sudden, the disease sets in in a few weeks and usually the onset is with an inaugural ketoacidotic coma.
In the case of LADA diabetes, the onset is slow, over a much longer period of time, without inaugural ketoacidotic coma. Similarly between type 1 diabetes and type LADA diabetes is the presence of autoimmune antibodies in the patient’s blood. Patients in both categories will have antibodies directed against the glutamic acid decarboxylase (Anti GAD) and antibodies against cytoplasmic islet-cell antibodies (ICA) positive. It is extremely important when we have a patient who is around the age of 30 and who is at the onset of diabetes, to test the antibodies mentioned above to clearly elucidate what type of diabetes he has.
The presence or absence of these antibodies in his blood will give us the correct diagnosis and appropriate treatment. Although at first LADA diabetes can be treated with diet and oral antidiabetics, if the patient has positive antibodies this means that his beta-pancreatic cells will be destroyed and eventually he will need insulin treatment. Patients with LADA diabetes often have other associated autoimmune diseases such as autoimmune thyroiditis, lupus, vitiligo, rheumatoid arthritis, celiac disease. This is similar in patients with type 1 diabetes, and they frequently associate other autoimmune pathologies.
The diagnosis of type LADA diabetes
In order to make this diagnosis, the patient must present at least two of these criteria:
- adult age at onset (between 25 and 50 years)
- normal weight patient (BMI <25kg / m2)
- acute symptoms at the onset of the disease
- coexistence of another autoimmune disease
history of the presence of an autoimmune disease in a family member. LADA type diabetes is therefore a particular form of diabetes, with multiple components found in type 1 diabetes but which also combines characteristics and components of type 2 diabetes, the most important being insulin resistance. This is why the name 1.5 diabetes seems to be justified, although the World Health Organization (WHO) has included LADA diabetes in the category of type 1 diabetes.
