Latent autoimmune diabetes of adults: From oral hypoglycemic agents to early insulin

Approximately 10% of phenotypic type 2 diabetics have islet autoantibodies and are referred to as having latent autoimmune diabetes of adults (LADA), and they land on early sulfonylurea failure and require insulin. Diagnosing LADA has treatment implications because of high risk of progression to ins...

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Bibliographic Details
Published in:Indian journal of endocrinology and metabolism 2012-03, Vol.16 Suppl 1 (7), p.S41-S46
Main Author: Poudel, Resham R
Format: Article
Language:English
Subjects:
Adults
Autoimmune
Diabetes
Drug therapy
Health aspects
Hypoglycemic agents
Insulin
islet autoantibodies
latent autoimmune diabetes of adults
Review
sulfonylurea failure
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Summary:Approximately 10% of phenotypic type 2 diabetics have islet autoantibodies and are referred to as having latent autoimmune diabetes of adults (LADA), and they land on early sulfonylurea failure and require insulin. Diagnosing LADA has treatment implications because of high risk of progression to insulin dependency. But often there is delay in insulin therapy, as there are no recommendations for islet antibody testing in adult-onset diabetes currently. LADA clinical risk score can identify adults at high risk who may benefit from antibody testing. The optimal treatment of LADA is not established. Early insulin therapy helps to achieve good metabolic control and better long-term outcomes by preserving β-cells and endogenous C-peptide secretion. Sulfonylureas are better avoided as they exhaust β-cells; glitazones and exenatide have favorable outcomes, whereas metformin needs to be used with caution. Understanding LADA will also bring new windows in managing type 1 diabetes. Information acquisition was done by reviewing the medical literature published since 1987, with particular attention to the natural history, genetic factors, and treatment of LADA.
ISSN:2230-8210
2230-9500
DOI:10.4103/2230-8210.94257