Latent Autoimmune Diabetes in Adults

• Published in: The journal of clinical endocrinology and metabolism 2009-12, Vol.94 (12), p.4635-4644
• Main Authors: Naik, Ramachandra G., Brooks-Worrell, Barbara M., Palmer, Jerry P.
• Format: Article
• Language: English
• Subjects: Adult; Autoimmune Diseases - genetics; Autoimmune Diseases - pathology; Autoimmune Diseases - therapy; Biological and medical sciences; Diabetes Mellitus - genetics; Diabetes Mellitus - immunology; Diabetes Mellitus - pathology; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Genetic Predisposition to Disease; Humans; Immunity, Humoral; Insulin Resistance - physiology; Insulin-Secreting Cells - physiology; Medical sciences; Pancreatitis - pathology; T-Lymphocytes - immunology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2009-1120

Context: Autoantibodies that are reactive to islet antigens are present at the time of diagnosis in most patients with type 1 diabetes. Additionally, approximately 10% of phenotypic type 2 diabetic patients are positive for at least one of the islet autoantibodies, and this group is often referred to as “latent autoimmune diabetes in adults (LADA).” These patients share many genetic and immunological similarities with type 1 diabetes, suggesting that LADA, like type 1 diabetes, is an autoimmune disease. However, there are differences in autoantibody clustering, T cell reactivity, and genetic susceptibility and protection between type 1 diabetes and LADA, implying important differences in the underlying disease processes. Evidence Acquisition and Synthesis: In this clinical review, we will summarize the current understanding of LADA based on the MEDLINE search of all peer-reviewed publications (original articles and reviews) on this topic between 1974 and 2009. Conclusions: In LADA, diabetes occurs earlier in the β-cell-destructive process because of the greater insulin resistance. Complexities arise also because of variable definitions of LADA and type 1 diabetes in adults. As immunomodulatory therapies that slow or halt the type 1 diabetes disease process are discovered, testing these therapies in LADA will be essential. A review of clinical, immunological, physiological, genetic, and therapeutic aspects of latent autoimmune diabetes in adults.