LADA (Latent Autoimmune Diabetes in Adults): Symptoms, Diagnosis and Treatment

Medically Reviewed By DR. ARJUN SUBASH KALASAPUR, MD (Pharmacology) December 7, 2023

Late Adult Diabetes, known as Latent Autoimmune Diabetes in Adults (LADA), manifests in adulthood and progresses gradually over time. Resembling Type 1 diabetes, LADA emerges when the pancreas ceases to produce insulin due to an autoimmune process damaging pancreatic cells. Unlike the rapid onset of Type 1 diabetes, LADA’s progression is more insidious, creating a unique set of considerations for both patients and healthcare providers.

Understanding the significance of LADA within the diabetes spectrum is vital for comprehensive patient care and public health awareness. As an autoimmune-driven diabetes subtype, LADA bridges the characteristics of Type 1 and Type 2 diabetes. Recognising its distinct features becomes paramount for accurate diagnosis, treatment, and long-term management.

LADA Diabetes Definition

Latent Autoimmune Diabetes in Adults, or LADA, is a subtype of diabetes that presents a unique amalgamation of features from both Type 1 and Type 2 diabetes. This diabetes variant typically emerges in adulthood and is characterised by a gradual decline in pancreatic function. The defining trait of LADA lies in its autoimmune origin — the body’s immune system mistakenly targets and damages the insulin-producing beta cells in the pancreas. Researchers often label LADA as a form of Type 1 diabetes that evolves more slowly in adults, earning it the moniker “diabetes type 1.5 LADA.” However, debates persist regarding its classification, with some viewing it as a variation of Type 1 diabetes occurring differently in adults than in children.

Distinct Features that Differentiate LADA from Other Diabetes Types

  • Unlike the rapid onset of Type 1 diabetes, LADA’s progression is more subtle, often leading to misdiagnosis or delayed diagnosis. Individuals with LADA may initially be diagnosed with Type 2 diabetes due to its adult-onset nature and then experience a slow decline in insulin production, resembling aspects of Type 1 diabetes.
  • Type 1 diabetes often manifests in childhood or adolescence with an abrupt onset of symptoms. LADA, on the other hand, develops more gradually in adulthood. On the other hand, it differs from Type 2 diabetes as it involves an autoimmune response, akin to Type 1.
  • Another differentiating factor is the response to oral medications. While individuals with Type 2 diabetes typically respond well to oral antidiabetic medications, LADA patients may find these less effective over time, mirroring the treatment trajectory of Type 1 diabetes.

Read More: Connections Between Diabetes and Hypertension.

Importance of Recognising LADA in Late Adulthood

The recognition of LADA holds paramount significance in late adulthood due to its distinct characteristics and implications for treatment. Misdiagnosis or delayed diagnosis can lead to suboptimal management strategies, potentially impacting long-term health outcomes. Moreover, early recognition of latent autoimmune diabetes of adulthood empowers affected people to actively participate in their treatment plan, fostering a proactive approach to diabetes management.

Common Symptoms of Latent Autoimmune Diabetes in Adults

Common Symptoms of Latent Autoimmune Diabetes in Adults

The latent autoimmune diabetes symptoms closely resemble those found in both Type 1 and Type 2 diabetes. These hallmark signs include:

  • Frequent Urination: Individuals may notice an increased need to urinate.
  • Excessive Thirst: Intense thirst, beyond normal levels, is a common symptom.
  • Fatigue: Profound tiredness can set in, affecting daily activities.
  • Unexplained Weight Loss: Despite no intentional changes in diet or lifestyle, individuals may experience noticeable weight loss.

However, what sets LADA apart is the gradual onset of these symptoms. Unlike the rapid emergence seen in Type 1 diabetes, LADA symptoms unfold over months. Interestingly, the symptoms may become more evident and manifest more quickly than expected in Type 2 diabetes.

Read More: Can Type 2 Diabetes be Reversed Permanently?

Understanding the Distinctive Features of LADA Symptoms

Understanding the Distinctive Features of LADA Symptoms

Autoimmune Origin:

LADA, like Type 1 diabetes, stems from an autoimmune process damaging the insulin-producing beta cells in the pancreas. However, the autoimmune progression in LADA occurs slowly, leading to a unique set of considerations for treatment.

Delayed Insulin Requirement:

Unlike Type 1 diabetes, where immediate insulin administration is often necessary, individuals with LADA may not require insulin right away. This feature allows for alternative management approaches initially.

Onset Age:

Symptoms of LADA typically manifest in individuals over 30, which is older than the usual onset age for Type 1 diabetes. This distinction, coupled with the pancreas’s continued production of some insulin, can result in initial misdiagnosis as Type 2 diabetes.

Healthy Weight:

Unlike Type 2 diabetes, where being overweight is a significant risk factor, individuals with LADA often maintain a healthy weight. This characteristic becomes a key identifier in the diagnostic process.

Open communication between individuals and healthcare providers is essential. Those diagnosed with Type 2 diabetes, especially if lean, physically active, or experiencing unexplained weight loss, should inquire about the possibility of LADA.

Read More: How to Reverse Prediabetes Naturally?

Diagnosing LADA Diabetes

LADA, often revealing itself between the ages of 30 and 50, poses unique challenges in diagnosis, necessitating specific blood tests for accurate confirmation.

LADA diagnosis requires comprehensive blood tests, with the GADA antibody test playing a crucial role. This test specifically detects the presence of glutamic acid decarboxylase antibodies in the blood, antibodies typically associated with Type 1 diabetes. Confirming the existence of these antibodies becomes a key indicator for LADA, aiding in distinguishing it from other diabetes types.

Moreover, a diagnostic screening tool, encompassing three distinct criteria, offers a valuable approach for identifying LADA in diabetic patients over 50:

  • HbA1C of 10% or Greater: Haemoglobin A1C, a measure of average blood sugar levels over several months, serves as an important parameter. A reading of 10% or higher raises suspicion of LADA.
  • Fasting Blood Glucose of 270 mg/dl or Higher: Elevated fasting blood glucose levels further contribute to the diagnostic criteria for LADA, providing a comprehensive picture of the individual’s glucose metabolism.
  • Low or Normal BMI: Body Mass Index (BMI) considerations set LADA apart from Type 2 diabetes. Individuals with LADA often have a low or normal BMI, distinguishing them from the typical association of high BMI with Type 2 diabetes.

The results from above blood test for LADA diabetes collectively enable healthcare professionals to pinpoint LADA accurately, paving the way for tailored treatment strategies.

Challenges in Diagnosing LADA Accurately

While advancements in diagnostic methods have enhanced our ability to identify LADA, challenges persist. One significant challenge stems from the varied presentation of LADA symptoms, which can overlap with those of other diabetes types. The slow progression of LADA may lead to misdiagnosis, particularly in cases where immediate insulin administration is not necessary.

Additionally, age-related factors can contribute to misclassification. Diabetic patients over 50 may be initially diagnosed with Type 2 diabetes due to the age group’s higher prevalence of this condition. The unique combination of diagnostic criteria, including HbA1C, fasting blood glucose, and BMI, seeks to address these challenges, yet the need for vigilance remains.

Read More: Know About Good Foods for Prediabetes

Treatment Approaches for LADA

Treatment Approaches for LADA

LADA, straddling the characteristics of Type 1 and Type 2 diabetes, requires a nuanced and personalised approach to address its unique challenges. Let’s explore the comprehensive strategies employed in the treatment of LADA.

  1. Insulin: As the autoimmune process gradually diminishes the pancreas’s ability to produce insulin, supplementing with exogenous insulin becomes essential to maintain optimal blood glucose levels.
  2. Insulin Sensitizers: Medications that enhance the body’s sensitivity to insulin, such as metformin, are commonly utilised in LADA treatment. These drugs work synergistically with insulin to improve its effectiveness, aiding in better blood sugar control.
  3. Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors: SGLT2 inhibitors, like empagliflozin and canagliflozin, represent another class of medications employed in LADA management. These drugs work by reducing glucose reabsorption in the kidneys, promoting its excretion in the urine.
  4. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: DPP-4 inhibitors, such as sitagliptin and saxagliptin, enhance insulin secretion while inhibiting glucagon release. This dual action contributes to improved blood glucose regulation in individuals with LADA.
  5. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists: Medications like liraglutide and exenatide fall under this category, stimulating insulin release and suppressing glucagon secretion. GLP-1 receptor agonists play a role in managing blood sugar levels in LADA.

Tailoring treatment plans for adult onset autoimmune diabetes, particularly LADA, requires a meticulous understanding of individual needs. Factors such as age, overall health, lifestyle, and the stage of LADA progression play crucial roles in crafting personalised approaches.

  • Age Considerations: Late onset of diabetes often coincides with other age-related health considerations. Balancing latent autoimmune diabetes treatment with the management of other health aspects becomes integral for holistic care. 
  • Individualised Medication Plans: The selection of medications should align with the individual’s response and tolerance. Adjustments may be necessary over time, reflecting the dynamic nature of LADA.
  • Regular Monitoring: Continuous monitoring of blood glucose levels and periodic reassessment of treatment plans ensure that interventions remain effective. This ongoing evaluation allows for timely adjustments as needed.

Read More: What is Glycemic Index And To Calculate?

Lifestyle modifications form a crucial component of LADA management, complementing pharmacological interventions. These changes contribute to overall well-being and can positively impact blood sugar control.

  • Regular Exercise: Engaging in regular physical activity aids in weight management, enhances insulin sensitivity, and promotes cardiovascular health. Tailored exercise plans should align with individual capabilities and preferences.
  • Healthy Diet Choices: Adopting a balanced and nutrient-rich diet is fundamental in LADA management. A good LADA diabetes diet may include whole foods, controlling carbohydrate intake, and considering meal timing contribute to stable blood sugar levels.
  • Weight Management: Maintaining a healthy weight is particularly relevant for individuals with LADA. This may involve weight loss strategies for those with excess weight or efforts to prevent unintentional weight loss in those with lower BMI.
  • Smoking Cessation: For individuals who smoke, quitting is a crucial step in diabetes management. Smoking can exacerbate diabetes-related complications and hinder overall health.

Read More: 15 Foods To Lower Blood Sugar Levels

Conclusion

Proactivity in diabetes management is key, especially in late adulthood where health considerations become increasingly complex. Individuals should engage in open communication with healthcare providers, sharing any symptoms or concerns promptly. Regular screenings, including blood glucose monitoring and relevant blood tests, contribute to early detection and intervention.

FAQs (Frequently Asked Questions)

Is LADA reversible?

LADA, like other forms of diabetes, is a chronic condition. While certain lifestyle changes and early interventions may help manage symptoms and improve overall health, LADA is not considered reversible.

How is LADA diabetes diagnosed?

LADA diagnosis involves specific blood tests, primarily the Glutamic Acid Decarboxylase Antibody (GADA) test. This test detects antibodies associated with autoimmune processes in the blood, a key indicator of LADA. Additionally, a diagnostic screening tool considers criteria such as HbA1C levels, fasting blood glucose, and BMI to aid in the identification of LADA in individuals, especially those over 30.

How is Type 1 diabetes diagnosed?

Type 1 diabetes is typically diagnosed through a combination of symptoms, blood tests, and medical history. Common diagnostic tests include measuring blood glucose levels, assessing HbA1C levels, and conducting antibody tests, such as the GAD antibody test.

Does metformin help with LADA?

Metformin, an insulin sensitizer commonly used in diabetes management, may be prescribed to individuals with LADA to improve insulin sensitivity. However, its effectiveness in LADA treatment can vary among individuals.

What percentage of type 1.5 diabetes?

The prevalence of LADA among individuals with diabetes is estimated to be around 5-10%. However, this percentage can vary based on population demographics and regional factors. LADA is often underdiagnosed or misdiagnosed as Type 2 diabetes, making accurate prevalence statistics challenging to determine.

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