LADA in a Diabetes Unit

Abstract

Introduction: Latent autoimmune diabetes in adults (LADA) is
an autoimmune disease, with insulin deficiency due to progressive
destruction of pancreatic islets. Around 2-12% of the
patients classified with diabetes mellitus type 2 have LADA.
The diagnosis is based on the 2006 Fourlanos criteria: age of
onset < 50 years, acute symptoms, BMI < 25 kg/m2, personal
or family history of autoimmune disease. The presence of at
least two of these clinical features justifies testing for GAD antibodies
(GADA). In these patients, anti-insulin antibodies (IAA)
are rare while GADA are usually present although they may
disappear over time.
Materials and methods: A retrospective study of the medical
records, collected in the period between January 1st, 2013
and December 31st, 2015, in the Diabetes Unit was performed.
Results: Fifteen patients with positive antibodies to LADA were
identified. Eight were male and seven were female. The mean
age at diagnosis was 43 years. The average body mass index
was 23.8 kg/m2. All patients had titles of GADA> 1U/mL (maximum
84, 34 U/L). 87% started treatment with insulin after the
diagnosis. The average time between diagnosis and insulin
treatment was 2 years. In 11 of these patients other autoimmune
diseases were diagnosed, the most frequent one was
thyroiditis (seven of 15 patients).
Conclusion: LADA occurs in adults with type 2 diabetes phenotype.
The diagnosis is vital so that insulin therapy can be
started early and other autoimmune diseases associated with
LADA can be diagnosed.