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World J Diabetes. Sep 15, 2010; 1(4): 111-115
Published online Sep 15, 2010. doi: 10.4239/wjd.v1.i4.111
Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity
Bimota Nambam, Shakti Aggarwal, Anju Jain
Bimota Nambam, Shakti Aggarwal, Anju Jain, Department of Biochemistry, Lady Hardinge Medical College, New Delhi 110001, India
Author contributions: Nambam B and Aggarwal S were responsible for collection of relevant information and drafting of manuscript; and Jain A corrected and approved the final manuscript.
Correspondence to: Anju Jain, MD, Professor, Department of Biochemistry, Lady Hardinge Medical College, New Delhi 110001, India. dranjujain@rediffmail.com
Telephone: +91-981-1519290
Received: December 25, 2009
Revised: August 27, 2010
Accepted: September 3, 2010
Published online: September 15, 2010
Abstract

Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas but patients eventually become insulin dependent more rapidly than with type II DM patients. Although they have a type II DM phenotype, patients have circulating beta (β) cell autoantibodies, a hallmark of type I DM. Alternative terms that have been used to describe this condition include type 1.5 diabetes, latent type I diabetes, slowly progressive Insulin Dependent Diabetes Mellitus, or youth onset diabetes of maturity. With regards to its autoimmune basis and rapid requirement for insulin, it has been suggested that LADA is a slowly progressive form of type I DM. However, recent work has revealed genetic and immunological differences between LADA and type I DM. The heterogeneity of LADA has also led to the proposal of criteria for its diagnosis by the Immunology of Diabetes Society. Although many workers have advocated a clinically oriented approach for screening of LADA, there are no universally accepted criteria for autoantibody testing in adult onset diabetes. Following recent advances in immunomodulatory therapies in type I DM, the same strategy is being explored in LADA. This review deals with the contribution of the genetic, immunological and metabolic components involved in the pathophysiology of LADA and recent approaches in screening of this distinct but heterogeneous clinical entity.

Keywords: Latent autoimmune diabetes in adults; Glutamic acid decarboxylase autoantibodies; Type 1 diabetes; Type 2 diabetes