A DIFFERENT DIABETES: LATENT AUTOIMMUNE DIABETES OF THE ADULT (LADA)

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WHAT IS LADA?

Latent Autoimmune Diabetes of the Adult (LADA) is a type of autoimmune diabetes which shares common features between type 1 and type 2 diabetes.It is also called Type 1.5 diabetes or slowly progressive autoimmune diabetes.The 3 common criteria for diagnosis of LADA are:
  • Adult onset:the age at diagnosis ranges from 15 to 30 years.However, nowadays Type 2 diabetes is being diagnosed in increasingly younger people.The youngest person to be diagnosed with type 2 diabetes is a three year old girl in Texas, USA.
  • Antibody positivity: Diabetes Associated Antibodies (DAA) are usually present in people with LADA.However this may not be quite so clear-cut, given that different laboratories may have different cut-off values.These DAA include antibodies to glutamic acid decarboxylase 65 (GAD 65), insulinoma-associated antigen, islet cell & zinc transporter 8. The commonest is GAD 65 antibody.Antibody levels may fluctuate and the type of positive antibody may change over a period of time.Even a transient increase in autoantibody indicates autoimmunity.
  • Insulin treatment: Arbitrary definition of LADA include a period without insulin treatment of at least six months, but the need to use insulin is usually at the discretion of the physician.

WHY DO YOU NEED TO KNOW IF YOU HAVE LADA?

  • Patients with LADA generally have worse HbA1c levels (measure of 3 month’s average blood sugar) than type 2 diabetes patients.
  • Often they are misdiagnosed as type 2 diabetes.Incorrect treatment will lead to higher loss of insulin producing beta cells of pancreas.
  • Studies have shown that patients with LADA need insulin treatment earlier than those with type 2 diabetes and therefore may need closer monitoring.
  • Patients with LADA have lower levels of C-Peptide. (Connecting peptide is a marker of insulin production by your body). C-Peptide levels influence treatment.
  • The sulphonylurea group of drugs like chlorpropamide,glyburide,glipizide etc which work by stimulating the pancreas to release more insulin, are not the right choice of drugs for people with LADA.
  • Despite greater use of insulin, patients with LADA have worse blood sugar control. Therefore there is something more that needs to be done.
  • When any one autoimmune condition is present, the chances of developing others are high. People with LADA have a higher incidence of thyroid autoimmunity. Hence it is important to screen for other diseases as well.

WHAT IS DIFFERENT ABOUT A FUNCTIONAL AND METABOLIC MEDICINE APPROACH?

In addition to testing for DAA we would look at the following:

  • Gut Health.
  • Gut dysbiosis
  • Intestinal Permeability Dysfunction (Leaky Gut)
  • Vitamin D3 levels
  • Chronic Inflammation
  • Sleep
  • Nutrient Depletion
  • Stress Response
  • Movement/Exercise
  • Test for other autoimmune conditions, particularly thyroid autoantibodies.
  • Risk for heart disease and stroke
  • Check for heart failure.

Should everybody be screened for LADA?

That will depend on your goals.I practice patient-participatory medicine. My duty as a physician is to provide you with correct information and help  you make the best decision for yourself.

You MAY BE INTERESTED IN READING:

Do you have autoimmune diabetes

Predictive Autoantibodies

Vitamin D and Autoimmunity

Ebook on Autoimmunity

REFERENCES
Gambelunghe, Giovanni, et al. "Increased risk for endocrine autoimmunity in Italian type 2 diabetic patients with GAD65 autoantibodies." Clinical endocrinology 52.5 (2000): 565-573.
Priyanka P. Brahmkshatriya, Anita A. Mehta, Banshi D. Saboo, and Ramesh K. Goyal, “Characteristics and Prevalence of Latent Autoimmune Diabetes in Adults (LADA),” ISRN Pharmacology, vol. 2012, Article ID 580202, 8 pages, 2012. doi:10.5402/2012/580202