9 LATENT Autoimmune Diabetes in Adults (LADA) Current Status.ppt

9 LATENT Autoimmune Diabetes in Adults (LADA) Current Status

1. LATENT: Autoimmune Diabetes in Adults
(LADA): Current Status
Dr. Kamal Kishore MD
Consultant Physician
Geetanjali Hospital, Hisar

2. Case Scenario
•A 39 year old woman presenting with new onset diabetes
•3 weeks history of fatigue, thirst, blurred vision, polyuria
•Past Medical History: Hypothyroidism, hyperlipidemia
•Medications: Thyroxine 100 mcg/day
•Family H/o: Nothing significant; Married, has 3 children

3. Case Scenario
•FPG 224 mg/dl, PPG 350 mg/dl, HbA1c-10.2%
•Weight: 58 kg, Height: 155 cm, BMI: 24 kg/m
2
•Not willing for insulin
•Metformin 500 mg bd, Glimepiride 1 mg bd

4. Diagnosis…
Type 2 Diabetes Mellitus

5. After 3 weeks…
•Mild improvement in symptoms
•FPG 204 mg/dl, PPG 313 mg/dl
•Vildagliptin 50 mg/day added to the regimen

6. After 4 weeks…
•FPG 180 mg/dl, PPG 298 mg/dl
Any change in diagnosis…?

7. Types Of Diabetes Mellitus
•Type 1
1A (autoimmune)
1B (idiopathic)
•Type 1.5 (LADA)
•Type 2
•GDM
•Other specific types of Diabetes
MODY, FCPD

8. MODY
•Autosomal dominant
•Age of onset < 25 years
•One of the parents diagnosed before 25 years
•Good response to OAD
•Genetic testing +

9. FCPD
•Lean stature
•Abdominal pain, steatorrhoea
•No ketosis
•X ray/USG abdomen: Diagnostic

10. •LADA patients share genetic features with both type 1 and type 2
diabetes
•Antibody positivity and clustering
•The presence of autoantibodies along with islet-reactive T cells in
both LADA and classic childhood type 1 diabetes provides strong
evidence that the underlying disease process in both patient
groups is autoimmune
LADA

11. Key difference between Type 1 diabetes and LADA is
not the age of the person when they’re diagnosed,
but the gradual way the disease progresses

12. LADA: Diagnostic Features
•Age > 30 years
•Presenting as “non-obese type 2 diabetes”
•Initially controlled with diet/diet + OAD
•Early failure of oral agents
Most type 2 patients do well on oral agents for several years
•Insulin dependency within months/years of diagnosis

13. When to suspect…?
1. Age < 50 yrs
2. Acute symptoms at onset
3. BMI < 25
4. Personal history of autoimmune disease
5. Family history of autoimmune disease

16. Management of LADA
•LADA patients do not require insulin for the first 3 to 6
months following diagnosis, but up to 80% will require insulin
within the next five years
•Most patients are treated according to standard
management guidelines for type 2 diabetes
•Due to destruction of the β-cells, they become insulin
dependent more rapidly than “classic” type 2 diabetes
Recognition is important so insulin treatment is not delayed as A1c
climbs

17. Summary
Clinical indicators that can aid in the diagnosis of
diabetes type:
–History of onset
–Family history
–Presence of autoimmune indicators
–Evidence of insulin resistance
Biochemical confirmation
–Anti GAD Antibody
–C-peptide level

18. ADA Statement
“For a patient, it is less important to
label the particular type of diabetes
than it is to treat it effectively”
American Diabetes Association. Diagnosis and classification of diabetes mellitus.
Diabetes Care 2006; 29: S43–S48