Current view of diagnosis and treatment of latent autoimmune diabetes in adults

Česká verzia

Authors: Jana Urbanová ¹; Ludmila Brunerová ¹; Jana Malinovská ²; Barbora Pelechová ²; Ludmila Koberová ²; Jan Brož ²
Authors place of work: Centrum pro výzkum diabetu, metabolismu a výživy, II. interní klinika 3. LF UK a FNKV Praha ¹; Interní klinika FN v Motole a 2. LF UK, Praha ²
Published in the journal: Vnitř Lék 2021; 67(2): 97-102
Category:

Summary

Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune disease arising at adulthood. LADA is characterized by a less intensive autoimmune process, slower progression and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus. The onset of LADA is usually in non-obese patients over 30, without prominent features of metabolic syndrome and insulin resistance. Nevertheless it may be falsely classified as type 2 diabetes, especially, when diagnosed in older age and for the possibility of non-insulin treatment for at least 6 months after diagnosis. LADA is treated early with insulin and combined with metformin in patients with a higher level of insulin resistance. Clinical studies suggested also effectivity of other oral antidiabetics enabling preservation of residual β-cell function, such as particularly incretines.

Keywords:

diabetes mellitus – diagnosis – GADA – LADA – therapy

Zdroje

1. Pozzilli P, Pieralice S. Latent Autoimmune Diabetes in Adults: Current Status and New Horizons. Endocrinol Metab (Seoul). 2018; 33(2): 147–159.

2. Šumník Z, Průhová Š. LADA and MODY: How do we know them? Med. Praxi 2016, 13(1): 26-29.

3. Mojto V. Monogénne formy diabetu mellitu a latentný autoimunitný diabetes u dospelých: Monogenic forms of diabetes mellitus and latent autoimmune diabetes in adults. Lekársky obzor: HERBA, 2013, 62(9), 346–349.

4. Carlsson S. Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes Front. Physiol., 26 March 2019 | https://doi.org/10.3389/ fphys.2019.00320

5. Naik RG, Brooks‑Worrell BM, Palmer JP. Latent autoimmune diabetes in adults. J Clin Endocrinol Metab 2009; 94(12): 4635–4444.

6. Buzzetti R, Zampetti S, Maddaloni E. Adult‑onset autoimmune diabetes: current knowledge and implications for management. Nat Rev Endocrinol. 2017; 13(11): 674–686.

7. Hawa MI, Kolb H, Schloot N et al., Action LADA consortium.Adult‑onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: Action LADA 7. Diabetes Care 2013; 36(4): 908–913.

8. Yang Z et al. Childhood diabetes in China. Enormous variation by place and ethnic group. Diabetes Care 1998; 21: 525–529.

9. Lampasona V, Petrone A, Tiberti C et al. Zinc transporter 8 antibodies complement GAD and IA-2 antibodies in the identification and characterization of adult‑onset autoimmune diabetes: Non Insulin Requiring Autoimmune Diabetes (NIRAD) 4. Diabetes Care. 2010; 33: 104–108.

10. Heneberg P, Šimčíková D, Čecháková M et al. Autoantibodies against ZnT8 are rare in Central‑European LADA patients and absent in MODY patients, including those positive for other autoantibodies. Journal of Diabetes and its Complications. 2019 Jan; 33(1): 46– 52. DOI: 10.1016/j.jdiacomp.2018. 10. 004.

11. Buzzetti R, Di Pietro S, Giaccari A et al. High titer of autoantibodies to GAD identifies a specific phenotype of adult‑onset autoimmune diabetes. Diabetes Care 2007; 30: 932–938.

12. Maddaloni E, Lessan N, Al Tikriti A, et al. Latent autoimmune diabetes in adults in the United Arab Emirates: clinical features and factors related to insulin‑ requirement. PLoS One. 2015; 10: e0131837.

13. Thomas CC, Philipson LH. Update on diabetes classification. Med Clin North Am. 2015 Jan; 99(1): 1–16

14. Fourlanos S, Perry C, Stein MS et al. A Clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care. 2006; 29: 970–975.

15. Zampetti S et al. High GADA titer increases the risk of insulin requirement in LADA patients: a 7-year follow‑up (NIRAD study 7). Eur J Endocrinol 2014; 171, 697–704.

16. Zhou Z et al. Rosiglitazone combined with insulin preserves islet beta cell function in adult‑onset latent autoimmune diabetes (LADA). Diabetes Metab Res Rev 2005; 21, 203–208.

17. Scheen AJ. Suspension of the commercialization of sibutramine and rosiglitazone in Europe. Rev Med Liege 2010; 65 (10): 574–579.

18. Kobayashi T, Nakanishi K, Murase T et al. Small doses of subcutaneous insulin as a strategy for preventing slowly progressive beta‑ cell failure in islet cell antibody‑positive patients with clinical features of NIDDM. Diabetes 1996; 45: 622–626.

19. Maruyama, T. et al. Insulin intervention in slowly progressive insulin‑dependent (type 1) diabetes mellitus. J Clin Endocrinol Metab 2008; 93: 2115–2121.

20. Zhao, Y. et al. Dipeptidyl peptidase 4 inhibitor sitagliptin maintains β‑ cell function in patients with recent‑onset latent autoimmune diabetes in adults: one year prospective study. J Clin Endocrinol Metab 2014; 99: E876–E880.

21. Johansen OE, Boehm B, Grill V et al. Beta‑ cell function in latent autoimmune diabetes in adults treated with linagliptin vs glimepiride: exploratory results from a 2-year double‑blind randomized controlled study. Endocr Rev. 2012; 33(4 Suppl): SUN–LB1.

22. Buzzetti R, Pozzilli P, Frederich R et al. Saxagliptin improves glycaemic control and C‑peptide secretion in latent autoimmune diabetes in adults (LADA). Diabetes Metab Res Rev 2016; 32: 289–296.

23. Jones AG, McDonald TJ, Shields BM et al. for the PRIBA Study Group. Markers of β‑Cell Failure Predict Poor Glycemic Response to GLP-1 Receptor Agonist Therapy in Type 2 Diabetes. Diabetes Care 2016 Feb; 39(2): 250–257.

24. Pozzilli P, Leslie RD, Peters AL et al. Dulaglutide treatment results in effective glycaemic control in latent autoimmune diabetes in adults (LADA): a post‑hoc analysis of the AWARD-2, -4 and -5 trials. Diabetes Obes Metab 2018; 20: 1490–1498.