Latent Autoimmune Diabetes in Adults is a type of diabetes that affects 4-12% or 17-50 million people out of 422 million with diabetes worldwide.  Although Type 1 and Type 2 diabetes are more well-known, LADA is not as well-known. This can lead to delays in diagnosis and treatment, which is why it is important to raise awareness of this condition.

Living with undiagnosed or misdiagnosed LADA can be frustrating and harmful. Symptoms such as fatigue, thirst, and frequent urination can be wrongly attributed to other conditions, resulting in ineffective treatments. This confusion and mismanagement can worsen health outcomes, making it essential to spread accurate information and increase awareness about LADA.

In this article, you will learn what LADA is, how it’s diagnosed, and why it’s different from typical Type 1 and Type 2 Diabetes. We will also explore effective management strategies to handle this condition better, offering hope and clarity to those dealing with this often misunderstood diagnosis.

Key Takeaways

  • Latent Autoimmune Diabetes in Adults (LADA) is a form of diabetes that blends characteristics of both Type 1 and Type 2 diabetes, often leading to it being termed Type 1.5 diabetes. It typically starts in adulthood and progresses more slowly than Type 1, sometimes delaying the need for insulin therapy.
  • Despite affecting a significant number of people worldwide, LADA is not as well-known as Type 1 and Type 2 diabetes. This lack of awareness can result in delayed diagnosis and treatment, underscoring the importance of increasing knowledge and understanding of this condition.
  • The primary cause of LADA is an autoimmune reaction in which the body’s immune system mistakenly attacks and damages the insulin-producing cells in the pancreas. Genetics, particularly certain HLA genes related to the immune system, play a significant role in an individual’s risk of developing LADA.
  • Lifestyle and environmental factors, such as being overweight, having a poor diet, low physical activity, and smoking, can also influence the risk of LADA. However, their impact is less pronounced than in Type 2 diabetes. Conversely, moderate alcohol consumption and the intake of fatty fish might help reduce the risk.
  • Diagnosis of LADA requires a combination of clinical evaluation and specific tests, including checking for the presence of autoantibodies targeting pancreatic islet cells, which help distinguish it from other types of diabetes.
  • Managing LADA effectively involves a comprehensive approach that includes monitoring blood sugar levels, possibly insulin therapy as the disease progresses, and adopting healthy lifestyle changes to manage the condition better and improve overall health outcomes.

What is Latent Autoimmune Diabetes in Adults (LADA)?

Latent Autoimmune Diabetes in Adults (LADA) is a type of diabetes that starts in adulthood and is somewhat of a mix between Type 1 and Type 2 diabetes and, therefore, has been termed Type 1.5 diabetes. People with LADA may initially not need insulin injections because their bodies still produce enough insulin independently, but they may need it later as the disease progresses. 

Unlike typical Type 1 diabetes, which usually starts in childhood and involves a quick loss of insulin production due to an immune system attack on pancreatic cells, LADA develops slowly. Similarly, while it shares some insulin resistance characteristics seen in Type 2 diabetes, it has a stronger autoimmune component, which is less common in Type 2.

LADA differs from other types of diabetes primarily in how and when it develops. In Type 1 diabetes, the immune system quickly destroys insulin-producing cells, leading to an immediate need for insulin. Type 2 diabetes typically arises from the body’s inability to use insulin effectively, primarily due to lifestyle factors and genetics, and often develops over many years. LADA, on the other hand, involves an autoimmune attack on the insulin-producing cells like Type 1 but progresses more slowly and appears initially more like Type 2, often delaying the need for insulin therapy.

What Causes LADA?

Latent Autoimmune Diabetes in Adults is primarily caused by an autoimmune response where the body’s immune system mistakenly attacks and damages the insulin-producing cells in the pancreas. Genetics play a significant role in LADA; certain genes related to the immune system, particularly the HLA genes, increase the risk of developing this condition. These genes influence how the immune system recognizes and interacts with the body’s cells, which can lead to autoimmune diseases like LADA.

While genetics are a major factor, lifestyle, and environmental factors also impact LADA, though their role is not as clearly defined as in Type 2 diabetes. Some studies suggest that lifestyle factors such as being overweight, having a diet high in sweetened beverages, and smoking might increase the risk of developing LADA, especially in those with a genetic predisposition. Physical activity and moderate alcohol consumption might help reduce the risk. However, these influences are generally weaker in LADA compared to Type 2 diabetes, and the exact ways lifestyle and environment affect LADA are still being researched.

Who is at Risk for Developing LADA?

Latent Autoimmune Diabetes in Adults primarily affects individuals who are typically diagnosed in adulthood, often around the age of 30 or older, but it can also occur in those who are younger. There are several key risk factors associated with the development of LADA:

  • Genetic Predisposition: Like Type 1 diabetes, LADA is often linked to specific genetic markers, especially certain human leukocyte antigen (HLA) genotypes, which play a crucial role in the immune system. These genetic factors can increase an individual’s susceptibility to the autoimmune processes that characterize LADA.
  • Autoantibodies: The presence of autoantibodies against pancreatic islet cells, particularly those targeting glutamic acid decarboxylase (GADA), is a significant marker. These autoantibodies indicate an immune-mediated attack on the pancreas’s insulin-producing beta cells.
  • Environmental and Lifestyle Factors: While the direct impact of lifestyle factors on LADA is less clear than in Type 2 diabetes, certain lifestyle choices are considered to increase risk. These include a high body mass index (BMI), poor diet, low physical activity, and smoking. Interestingly, some studies suggest that moderate alcohol consumption and the intake of fatty fish reduce the risk of developing LADA.

How is LADA Diagnosed?

A blood sample image of insulin autoantibody test

Latent Autoimmune Diabetes in Adults is diagnosed through a combination of clinical evaluation and specific tests that help distinguish it from other types of diabetes. Here’s how it’s typically diagnosed:

  • Autoantibody Tests: The presence of certain autoantibodies is a key indicator of LADA. The most common is the glutamic acid decarboxylase antibodies (GADA). Others may include insulinoma-associated-2 antibodies (IA-2A) and zinc transporter 8 antibodies (ZnT8A).
  • C-Peptide Test: This test measures the level of C-peptide in the blood, which is an indicator of how much insulin is being produced by the pancreas. People with LADA typically have lower than normal C-peptide levels if their beta-cell function has started to decline, but not as low as in someone with advanced Type 1 diabetes.

What are the LADA Diabetes Symptoms?

Latent Autoimmune Diabetes in Adults often presents with symptoms that can initially resemble those of Type 2 diabetes, but it also shares characteristics with Type 1 diabetes. Here are the typical symptoms and how they compare to other types of diabetes:

Symptoms of LADA

  • Polyuria: Increased frequency of urination, especially noticeable during the night.
  • Polydipsia: Excessive thirst and an increased intake of fluids.
  • Fatigue: Feeling unusually tired or lethargic.
  • Weight loss: Unexplained weight loss despite normal or increased eating.
  • Blurred vision: Visual disturbances not associated with a known eye condition.

These symptoms can develop more gradually than in Type 1 diabetes but may appear more rapidly than in Type 2 diabetes, reflecting the intermediate nature of LADA.

Comparison with Other Types of Diabetes

  • Type 1 Diabetes (T1DM): In T1DM, symptoms usually develop suddenly and are more severe at diagnosis. Common symptoms include significant weight loss and the rapid onset of polyuria and polydipsia. Due to the rapid and extensive loss of insulin-producing beta cells, patients with T1DM typically require insulin from diagnosis.
  • Type 2 Diabetes (T2DM): Symptoms in T2DM tend to develop more slowly over several years and may be subtler. Many patients with T2DM might initially have no symptoms or only mild symptoms, which can delay diagnosis. Symptoms like fatigue and frequent infections are more common. Obesity and a sedentary lifestyle are also more typically associated with T2DM.

What Complications Can Arise from LADA?

A foot suffering from a neuropathy problem

Latent autoimmune diabetes in adults is associated with several complications and long-term health issues, similar to those seen in both type 1 and type 2 diabetes (T1DM and T2DM). Here are the fundamental complications and long-term health issues associated with LADA:

Complications

Microvascular Complications

  • Neuropathy: Small-fiber neuropathy (SFN) occurs early and more frequently in LADA compared to T2DM. This affects small nerve fibers that carry pain temperature sensations and help regulate blood flow.
  • Retinopathy: Routine screening is recommended as diabetic retinopathy is a risk in all forms of diabetes, including LADA.
  • Nephropathy: Regular kidney function and urine albumin screening are suggested due to the risk of diabetic nephropathy.

Macrovascular Complications

  • Cardiovascular Disease: Patients with LADA have similar risks of cardiovascular diseases, such as heart attacks and strokes, as those seen in T1DM and T2DM. Studies like the Botnia study and the HUNT study indicate increased cardiovascular disease and mortality in LADA, which aligns closely with the risks of T2DM.
  • Insulin Resistance and Metabolic Syndrome: Despite its autoimmune nature, LADA also shares features with T2DM, such as insulin resistance and metabolic syndrome, contributing to its complications.

Long-Term Health Issues

  • Progressive Beta-cell Destruction: Over time, LADA typically leads to a gradual loss of beta-cell function, necessitating insulin therapy as the disease progresses.
  • Higher Risk of Severe Glycemic Events: Due to the nature of the disease and common misdiagnosis, patients with LADA might experience severe hyperglycemia before proper diagnosis and treatment are established.
  • Bone Health: Evidence suggests altered bone metabolism in LADA, which may differ from the mechanisms seen in T2DM, potentially leading to bone resorption and health issues.
  • Increased Mortality: As highlighted by the HUNT study, mortality in LADA is chiefly influenced by poor glycemic control, with cardiovascular disease being a significant contributor.

How is LADA Managed and Treated?

Latent Autoimmune Diabetes in Adults (LADA) is managed with a combination of lifestyle interventions and medication tailored to individual needs to slow disease progression and effectively manage blood glucose levels. Lifestyle changes such as a healthy diet, regular exercise, and maintaining a healthy weight are fundamental. They can significantly impact the management of LADA by improving glycemic control and reducing insulin resistance. 

Typically, people with LADA are initially treated with medications used for Type 2 diabetes, like metformin, to improve insulin sensitivity, though its effectiveness can vary. Studies also show that LADA patients may initially respond to oral agents but generally require insulin within five years of diagnosis due to the rapid decline in pancreatic beta-cell function, a characteristic more aligned with type 1 diabetes. 

For example, a case study highlighted in the text shows a patient initially misdiagnosed with type 2 diabetes but later required insulin therapy to achieve good glycemic control. In terms of preserving beta-cell function, additional treatment options include dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and thiazolidinediones, which help maintain insulin production. 

Conversely, treatments like sulfonylureas, which can hasten beta-cell depletion, are avoided. The importance of accurate diagnosis and appropriate management is stressed to prevent long-term complications and improve the quality of life for patients with LADA.

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Conclusion

In conclusion, Latent Autoimmune Diabetes in Adults (LADA) is a complex condition that requires proper diagnosis and management to ensure the best possible health outcomes. It is crucial to raise awareness about LADA to improve early detection and treatment and to provide hope and clarity to those affected by this often misunderstood diagnosis. With ongoing research and effective management strategies, those living with LADA can lead healthy and fulfilling lives. Remember to consult with a healthcare professional if you have any concerns or questions about LADA or any other health condition.

FAQs About Latent Autoimmune Diabetes in Adults

What triggers LADA?

Risk factors for Latent Autoimmune Diabetes in Adults include a history of low birth weight, which is a significant risk factor for both LADA and Type 2 Diabetes Mellitus (T2DM). Lifestyle factors such as smoking, alcohol consumption, and the consumption of sweetened beverages also contribute to the risk. Additionally, the amount and type of physical activity and exercise are important to assess and document, as they help in quantifying the risk of developing LADA.

Does lada diabetes shorten your life?

Life expectancy in individuals with LADA can be similar to those with other types of diabetes, contingent on effective management and control of blood sugar levels. Chronic high blood sugar can lead to complications associated with diabetes, such as kidney disease, cardiovascular issues, eye disease, and neuropathy. These complications can negatively impact life expectancy and quality of life, making it crucial to manage the condition proactively.

What is the ICD-10 code for latent autoimmune diabetes in adults?

The ICD-10 code for Latent Autoimmune Diabetes in Adults, which is considered diabetes due to an autoimmune disease, is E10. It’s important to note that there is an exclusion note under the E13 category, specifying that diabetes due to autoimmune causes should be coded as E10, not under other diabetes categories.

Is latent autoimmune diabetes in adults hereditary?

Evidence suggests that LADA has a distinct genetic background that differs from both Type 1 Diabetes Mellitus (T1DM) and T2DM. Specifically, the influence of HLA haplotypes commonly associated with T1DM is less pronounced in LADA, while polymorphisms in genes like PTPN22, INS, and SH2B3 are more prevalent compared to T2DM. This indicates a unique genetic predisposition for LADA, differentiating it from other diabetes types.

Can stress cause LADA?

Research findings indicate a significant correlation between emotional stress and the onset of LADA. While the exact mechanisms are still being explored, several hypotheses suggest how stress might influence the development of LADA, underlining the importance of managing stress as part of a comprehensive approach to reduce the risk of LADA potentially.

Does exercise help LADA?

Engaging in physical activity, such as exercising for 30 minutes three times per week, has been associated with a 40% reduction in the risk of developing LADA. This protective effect is particularly notable in individuals who do not carry a high genetic risk for diabetes, emphasizing the beneficial role of exercise in LADA prevention and management.

Can type 2 diabetes turn into LADA?

While a diagnosis of Type 2 Diabetes Mellitus (T2DM) cannot transform into Type 1 Diabetes Mellitus (T1DM), it is crucial to recognize that some individuals initially diagnosed with T2DM may actually have LADA, also known as Type 1.5 diabetes. This is due to the autoimmune nature of LADA, which can lead to a requirement for insulin therapy over time, similar to T1DM.

Can LADA be controlled with diet?

There are cases where individuals diagnosed with LADA have managed to control their condition without insulin, primarily through dietary modifications such as adopting a high-protein ketogenic diet. While this approach may not be suitable for everyone, it highlights the potential of diet in managing LADA, underscoring the importance of personalized treatment plans.

Can you use metformin in LADA?

Although LADA patients are often initially treated with metformin under the presumption of T2DM, the effectiveness, and appropriateness of metformin in LADA are still subjects of ongoing research.

How can LADA be prevented?

Preventive strategies for LADA may overlap with those for T2DM, including lifestyle modifications such as maintaining a healthy weight, engaging in regular physical activity, and quitting smoking. However, the evidence base for these recommendations is primarily derived from studies, and more research is needed to understand the preventability of LADA fully.

Sources

Rajkumar, V., & Levine, S. N. (2022). Latent Autoimmune Diabetes. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557897/

Diabetes UK. (n.d.). Latent Autoimmune Diabetes in Adults (LADA). Retrieved May 8, 2024, from https://www.diabetes.org.uk/diabetes-the-basics/other-types-of-diabetes/latent-autoimmune-diabetes

O’Neal, K. S., Johnson, J. L., & Panak, R. L. (2016). Recognizing and appropriately treating latent autoimmune diabetes in adults. Diabetes Spectrum, 29(4), 249–252. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5111528/