Latent Autoimmune Diabetes in Adults (LADA) in Recent Clinical Practice

Hiroshi Bando

Tokushima University and Medical Research, Nakashowa 1-61,Tokushima 770-0943, JapanJapan

DOI: https://doi.org/10.17140/droj-5-e014 · Published 2019-04-02 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2019 The Author(s)

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Open Journal PUBLISHERS Editorial Latent Autoimmune Diabetes in Adults (LADA) in Recent Clinical Practice * Hiroshi Bando, MD, PhD, FACP* Tokushima University and Medical Research, Nakashowa 1-61,Tokushima 770-0943, Japan * *Corresponding author Hiroshi Bando, MD, PhD, FACP Instructor,Tokushima University and Medical Research, Nakashowa 1-61,Tokushima 770-0943, Japan;Tel. +81-90-3187-2485; Fax: +81-88-603-1030; E-mail: pianomed@bronze.ocn.ne.jp Article information st nd nd Received: April 1 , 2019; Accepted: April 2 , 2019; Published: April 2 , 2019 Cite this article Bando H. Latent autoimmune diabetes in adults (LADA) in recent clinical practice. Diabetes Res Open J. 2019; 5(1): e4-e6. doi: 10.17140/DROJ-5-e014 iabetic patients have been increasing and this tendency has LADA is characterized for its rather less intensive auto- 1 10 become a medical and social problem worldwide.1 There are immune situation and its broad clinical features.10 Patients with D some types of diabetes, in which the prevalence of type 2 diabetes LADA are initially insulin independent at early stages and can mellitus (T2DM) has been higher without requiring insulin treat- be checked by examination of islet-cell autoantibodies. Then, it ment. On the other hand, type 1 diabetes mellitus (T1DM) has is rather difficult to diagnose LADA in the usual clinical setting. acute onset due to virus infection. Under such circumstances, there Probably, there are lots of cases of LADA which would exist in the is a disease that has been clinically important in recent years. It is large group of T2DM with higher misdiagnosis rate. Latent autoimmune diabetes in adults (LADA).

As a matter of fact, the screening test for ICAs would be As to LADA, there are both clinical and immunological necessary for the patients with newly diagnosed as T2DM. Unless characteristics between T2DM and T1DM. The genesis of T1DM this exam of antibodies is performed, a gradual decrease in the has been the autoimmune destruction of islet β-cells in the pancre- ability of insulin secretion may be found later after years.10 Con- as. There are some major anti-islet autoantibodies, such as glutamic sequently, LADA may show slower decreased pancreas function acid decarboxylase autoantibody (GADA), and T1DM shows a compared with that of T1DM. Furthermore, patients with LADA 2,3 high prevalence of GADA.2,3 can prepare the pathophysiological changes in advance a few years later, with the adequate therapeutic approach of diabetic treat- When positive GADA is observed in the patient with ment.

T2DM, the patient does not require insulin treatment during the early stage, but the patient may become insulin-dependent status LADA has been characterized for the presence of spe- within a few years. This subtype of diabetes has been called LADA cific autoantibodies for the islet cells. It includes GADA and IA-2 4 11 mainly in Europe and North American region.4 In contrast, in antibodies.11 This type is often diagnosed as T2DM at an early Japan and the Asian region, it has been called slowly progressive stage, but a few years later its diabetic status will develop to the insulin-dependent (type 1) diabetes mellitus (SPIDDM),5 and/or degree similar to T1DM. This situation has been as rather popu- LADA.6 lar in adulthood as in childhood.11 Thus, there is a possibility of misdiagnosis between T2DM and LADA just after the diagnosis The characteristic point of LADA would be a conceptual of diabetes. These patients are defined as LADA which has been phenotype that exists between conventional T1DM and T2DM. one of the subtypes of autoimmune diabetes.12 Its specific points Recently, there has been some clinical issues and challenges for would be more heterogeneous than T1DM in a young person and LADA.7 They include the prevention of progressive β-cell failure slower changes to β-cell failure for years with necessary treatment by dipeptidyl peptidase-4 (DPP-4) inhibitors, Glucagon-like pep- of insulin.13 tide-1 (GLP-1) analogs, metformin, and insulin.8 Furthermore, there was an investigation of islet cells and exocrine pancreatic From the guidelines of the Immunology of Diabetes So- tissues in the pancreas for LADA which were positive for GADAs ciety (IDS), a patient with LADA has been defined by i) adult age and islet cell antibody (ICA).9 of onset usually more than 30-years, ii) insulin independence at cc Copyright 2019 by Bando H. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. Diabetes Res Open J. 2019; 5(1): e4-e6. doi: 10.17140/DROJ-5-e014 onset for at least 6-months, iii) positive results for islet-cell autoan- areas. When the patient is diagnosed as LADA, autoantibodies and tibodies.13 In contrast, there have much discussion and controversy the clinical course should be carefully monitored. The pathogen- concerning the definition of LADA. It is rather difficult to show esis for LADA has been gradually elucidated and the development clear diagnostic guidelines at present. Consequently, the various of future research is expected.

situation of LADA includes heterogeneous matters in phenotypic, immunological and genetic features. These phenomena probably

References

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