Diabetes LADA

LADA stands for Latent Autoimmune Diabetes of Adulthood. LADA is a form of type 1 diabetes that develops later into adulthood.

LADA tends to develop more slowly than type 1 diabetes in childhood and, because LADA can sometimes appear similar to type 2 diabetes, doctors may mistakenly diagnose LADA as type 2 diabetes.

The definition provided by Prof. David Leslie, Principle Investigator of Action LADA, is that in Europe:

LADA is defined as initially non-insulin requiring diabetes diagnosed in people aged 30-50 years with antibodies to GAD – glutamic acid decarboxylase.

How does LADA compare with other diabetes types?

LADA is sometimes referred to as type 1.5 diabetes. This is not an official term but it does illustrate the fact that LADA is a form of type 1 diabetes that shares some characteristics with type 2 diabetes.

As a form of type 1 diabetes, LADA is an autoimmune disease in which the body’s immune system attacks and kills off insulin producing cells.

The reasons why LADA can often be mistaken for type 2 diabetes is it develops over a longer period of time than type 1 diabetes in children or younger adults.

Whereas type 1 diabetes in children tends to develop quickly, sometimes within the space of days, LADA develops more slowly, sometimes over a period of years.

The slower onset of diabetes symptoms being presented in people over 35 years may lead a GP to initially diagnose a case of LADA as type 2 diabetes.

Symptoms of LADA

The first symptoms of LADA include:

• Feeling tired all the time or regularly tired after meals
• Foggy headedness
• Experiencing hunger soon after meals

As LADA develops, a person’s ability to produce insulin will gradually decrease and this may lead to symptoms such as:

• A hard to quench thirst
• Needing to frequently urinate
• Blurred vision
• Tingling nerves

It is important to catch the symptoms at the earliest stage because diagnosis of LADA at a later stage increases the risk of developing diabetes complications.

Having tingling nerves can be a sign of neuropathy (nerve disease) so if this symptom is appearing regularly, especially if in addition to other symptoms listed above, it is advisable to see a doctor.

How common is LADA?

According to the UK Prospective Diabetes Study found that antibodies specific to LADA cases are found in between 6% and 10% of diabetes cases. Amongst people diagnosed with diabetes at an age younger than 35 years old, LADA may account for up to 25% of cases.

How is LADA diagnosed?

Often LADA will be initially diagnosed as diabetes by way of the usual diagnosis procedures.

Following a diagnosis of diabetes, your doctor or you may have reason to suspect that the type of diabetes present is LADA.

Determining the presence of LADA is achieved by examining the presence of elevated levels of pancreatic autoantibodies amongst patients who have recently been diagnosed with diabetes but do not require insulin.

A GAD Antibody test can measure the presence of these autoantibodies.

These antibodies can identify LADA, and also can predict the rate of progression towards insulin dependency.

Another test that can be performed is a C-peptide test. However, C-peptide tests may not always draw conclusive results in people with LADA at an earlier stage of the condition’s development.

LADA can be misdiagnosed

As noted, because of the age at which it can develop and the slower onset of the condition, LADA can often be mistakenly misdiagnosed as type 2 diabetes.

It is beneficial if LADA is diagnosed correctly as if LADA is incorrectly diagnosed as type 2 diabetes, it could lead inappropriate treatment methods that could lead to poorer diabetes control and could accelerate the loss of insulin producing ability.

There are some clues that can give rise to a clinical suspicion of LADA rather than type 2 diabetes. These include:

• An absence of metabolic syndrome features such as obesity, high blood pressure and cholesterol levels
• Uncontrolled hyperglycemia despite using oral agents
• Evidence of other autoimmune diseases (including Graves’ disease and Anaemia)

Note that some people with LADA can exhibit features of metabolic syndrome such as being overweight or obese which may complicate or delay a diagnosis of LADA.

How is LADA treated ?

Because LADA develops slowly, someone with LADA may be able to produce enough of their own insulin to keep sugar levels under control without needing insulin for a number of months or sometimes even years after the initial diagnosis of diabetes.

Insulin will almost certainly be required at some point in the future.

In some cases, insulin therapy may be postponed. However, there is evidence to suggest that starting insulin treatment soon after a diagnosis of LADA will help to better preserve the pancreas’ ability to produce insulin.

Regular blood glucose testing is advised for people with LADA at a similar number of tests per day that are advised for people with type 1 diabetes.

This means that it is advisable to test your blood sugar levels before each meal and before bed. ^[181]

What complications are related to LADA?

Ketoacidosis is a short-term complication of LADA, particularly once the pancreas has lost much of its ability to produce insulin

People with LADA should be aware of the signs of ketoacidosis and how to test for ketones if needed.

The risks of long term complications of diabetes will be similar to the risks in people with type 1 and type 2 diabetes.

The possible long term complications of diabetes include:

• Heart disease and stroke
• Retinopathy (retinal disease)
• Nephropathy (kidney disease)
• Neuropathy (nerve disease)
• Foot problems

What complications are related to LADA?

Ketoacidosis is a long-term complication of LADA, particularly once insulin dependence develops.

Cardiovascular disease risks are similar to those of type 2 diabetics, but if this complication develops hyperglycaemia is a stronger risk factor.

Microvascular complications such as retinopathy and neuropathy are similar to those people with type 2 diabetes.

How is LADA managed?

The treatment of LADA needs to focus on controlling hyperglycaemia and preventing the onset of any complications.

It is important to preserve beta cell function amongst LADA patients for as long as possible. Insulin can be used to treat LADA, as can metformin and thiazolidinediones

Anything that can help to restore beta cell function should be considered.