LADA

Abstract

Latent autoimmune diabetes in adults (LADA) is a slowly progressive type of diabetes (DM) of autoimmune origin with characteristics similar to type 1 and type 2 diabetes (T1D) in adults, which frequently leads to diagnostic errors and, therefore, delays in initiating insulin therapy. For this reason, in the case of adult patients with a phenotype atypical to T2D, early antibody screening is recommended for accurate diagnosis and, consequently, appropriate therapy.

Tuomi et al. identified anti-glutamic acid decarboxylase antibodies (GADA) in adult patients who did not require insulin at onset more than 30 years ago. However, its diagnostic criteria and categorization as a variant of T1D remain a subject of debate.

The presence of other concomitant autoimmune diseases influences the prognosis of patients diagnosed with LADA, reinforcing the need for a holistic evaluation, avoiding a glucocentric approach. There is evidence that the cardiovascular risk in these patients is increased, even when compared to other classic types of diabetes mellitus (DM) such as type 1 and type 2 DM; therefore, it is suggested that they should have a different risk stratification than the current one.

Given the heterogeneity of these patients, therapeutic strategies have a promising future beyond insulin. For example, post-hoc analyses of the SURPASS study in GADA-positive patients showed improvements in both glycated hemoglobin and body weight with tirzepatide treatment, opening a door of opportunities to explore other clinical alternatives.