What is latent autoimmune diabetes in adults?

Latent autoimmune diabetes of adults (LADA), otherwise known as type 1.5 diabetes, is a less common form of diabetes that affects adults.

People with LADA may present with signs and symptoms of both type 1 and type 2 diabetes, which makes diagnosing LADA more challenging.

In this article, we discuss what LADA is and how it differs from other forms of diabetes.

What is it?

LADA is a type of diabetes that affects adults, typically after 35 years of age. People living with LADA may show signs of both type 1 and type 2 diabetes.

In LADA, people develop antibodies that affect the ability of the pancreas to control blood sugar.

People living with LADA may initially be insulin-independent, which means their pancreas can still produce insulin.

Doctors may diagnose these individuals with type 2 diabetes. However, people with type 2 diabetes do not develop the antibodies that cause LADA.

Unlike type 1 diabetes, LADA progresses slowly, which explains why it is diagnosed later in adulthood.

LADA may account for 2–12% of all cases of diabetes in the adult population.

LADA vs. other types

LADA is different from type 1 and type 2 diabetes.

Doctors typically diagnose type 1 diabetes in children and adolescents, but the peaks in its presentation occur between 5–7 years old and around puberty.

In type 1, antibodies attack the cells of the pancreas. Since the pancreas cannot produce enough insulin, people with type 1 diabetes must use insulin injections to control their blood sugar.

Type 2 diabetes is a metabolic disease that results from defective insulin action.

Type 2 diabetes affects middle-aged and older adults with high blood sugar due to previous lifestyle choices and eating habits.

LADA is more similar to type 1 diabetes than type 2. This similarity may be why doctors sometimes call it type 1.5 diabetes.

As with type 1 diabetes, people living with LADA typically have a lower body mass index (BMI) than people living with type 2 diabetes.

LADA also presents with some characteristics of type 2 diabetes, such as older age at diagnosis and deficiencies in insulin or decreased function of insulin.

Symptoms

LADA may present with very broad symptoms, such as ketoacidosis, which can cause a distinctive fruity odor on the breath and high blood sugar.

Some individuals with LADA will present with symptoms of both type 1 and type 2 diabetes.

These may include:

• excessive thirst
• frequent urination
• excessive hunger
• extreme fatigue
• blurry vision
• cuts and bruises that heal slowly
• weight loss despite eating more (type 1)
• tingling, pain, or numbness in the hands or feet (type 2 diabetes).

Causes

The cause of LADA is the development of autoantibodies against pancreatic cells, insulin, or enzymes involved in pancreatic functions.

Antibodies affecting the pancreas and its function may influence the way the body responds to blood sugar.

Experts suggest that LADA may share come genetic features of type 1 and type 2 diabetes. This may explain why LADA shares some of the clinical features of both forms.

However, researchers do not know if there are any specific genetic factors for LADA.

Treatment

Doctors have not yet established absolute guidelines for treating LADA.

The goal of the treatment is to preserve the pancreatic cell function. To do so, a person can sometimes use insulin injections.

Also, some antidiabetic drugs may help slow down pancreatic cell destruction, including DPP-4 inhibitors and glucagon-like peptide-1 receptor agonists.

However, doctors may recommend a personalized treatment strategy, depending on each case, and the symptoms an individual is displaying.

Complications

Similarly to type 2 diabetes, people with LADA may be at risk of microvascular complications, including:

• kidney damage
• nerve damage causing pain, tingling, and loss of sensation in the hands and feet
• disorders of the eye and vision.

Some experts suggest that people with LADA may have a higher chance of developing cardiovascular conditions than people with type 2 diabetes. People with LADA may have higher blood cholesterol levels than those with type 2 diabetes.

Diabetic ketoacidosis (DKA) is another potential complication of LADA.

DKA can occur when the cells are unable to receive the glucose that they need, and the body instead burns fat for energy. This can produce ketones, which are responsible for the fruity odor of the breath.

DKA is a serious condition that can lead to diabetic coma. Symptoms may include:

• signs of high blood sugar
• unintentional weight loss
• vomiting
• weakness
• changes in mental state.

Risk factors

Some risk factors for developing LADA include:

• obesity or excessive weight
• low birth weight
• low physical activity.

Researchers suggest that people with multiple risk factors may have higher chances of developing LADA. For example, the combination of low birth weight and adult overweight may increase the chance of LADA.

Psychosocial stress may also be a risk factor for developing LADA.

Diagnosis

Doctors may find it challenging to tell the difference between LADA and type 2 diabetes.

Some characteristics of LADA may prompt doctors to conduct further screening to help distinguish between types of diabetes.

Doctors typically diagnose LADA in people over 35 years of age, which is consistent with a diagnosis of type 2 diabetes.

People living with LADA may initially respond well to nutrition and lifestyle changes and oral medications, but their response usually declines.

People living with LADA will test positive for at least one antibody directed against the pancreatic cells, insulin, or enzymes involved in pancreatic function.

C-peptide is another factor that helps doctors distinguish between types of diabetes. People living with LADA may have low to normal blood levels of C-peptide, whereas levels are lower in type 1 and type 2 diabetes.

When to see a doctor

People experiencing unexplained excessive thirst or hunger, or frequent urination should see a doctor.

To test for diabetes, doctors will request blood tests to check several blood sugar markers.

DKA may occur in people who delay seeing a doctor for symptoms of diabetes. DKA can signify that a person’s diabetes is getting worse.

People should report DKA symptoms immediately to a doctor as the condition can be life-threatening.

Summary

LADA is a type of diabetes diagnosed in adulthood.

People living with LADA may present typical symptoms of type 2 diabetes, but their bodies produce antibodies that affect the way the body controls blood sugar.

People living with LADA may use insulin injections or other medications to control their blood sugar and slow down the destruction of the pancreas.

Source: Medical News Today

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