Latent autoimmune diabetes in adults: complication, management and treatment modalities

Abstract

Latent autoimmune diabetes in adults is phenomenal and most commonly referred as “late onset diabetes”, initially defined as “non-insulin” dependent diabetes as reported in individuals older than 30 years. Autoimmune diabetes could be a heterogeneous illness which might arise at any age and affects 10% of people older than 35 years and 25% below that age. When we compare childhood onset type1 diabetes with adult-onset autoimmune diabetes, it actually has less Human Leucocyte Antigen (HLA) which is associated with genetic risk and fewer diabetes-associated autoantibodies as well. Despite the presence of islet antibodies at the time of diagnosis, the death progression of autoimmune beta-cell is slow. Subjects with adult onset insulin dependent diabetes mellitus who do not necessitate hypoglycemic agent medical aid for a minimum of six months after diagnosis are demarcated as having LADA. LADA is characterized by serological evidence of islet autoimmunity in the setting of diminished and declining insulin secretion. How and by whom the diagnosis is made and above all on the requirement for exogenous insulin at the time of diagnosis create a distinction between LADA and adult onset type1 diabetes. In concurrence with demonstrated impaired beta-cell work at diagnosis of diabetes, insulin is the treatment of choice. Although it has closer pathophysiological resemblance to type 1 diabetes, phenotypically LADA is often misdiagnosed and treated as type2 diabetes due to both lack of knowledge and awareness among physicians to find some standardized diagnostic criteria and started on oral hypoglycemic. This condition of autoimmune diabetes share clinical and metabolic features with both type 1 and type 2 diabetes.