Late Autoimmune Diabetes of Adults ("LADA") is often referred to as "the other diabetes," or diabetes 1.5. LADA is a slowly developing form of Type 1 diabetes and can be seen at any age, but is most commonly found in adults. LADA is often misdiagnosed as Type 2 diabetes (because of the age of onset), but people with LADA do not always have insulin resistance like those who have Type 2 diabetes. LADA is characterized by age, positive antibodies, a gradual increase in insulin requirements and decreasing ability to make insulin as indicated by a low C-peptide.
Despite the prevalence of LADA and its increasing attention, we still have no clear universal guidelines as to how to test for or treat it. As a clinician, a majority of my case load is educating patients with Type 2 diabetes. Because I have only worked with a handful of patients with LADA, I consulted with Evan Sisson, Pharm.D., MHA, CDE, associate professor of VCU School of Pharmacy, to gain additional information about LADA. Sisson is also a certified diabetes educator and clinician. He has worked with many patients who have LADA and gave me some valuable information on the topic. Below are some of things we discussed:
Q: What is the Prevalence of LADA?
A: It is estimated that 2-12% of the Type 2 diabetes population have LADA. Frequently, these patients are treated as having Type 2 diabetes and need to progress to insulin much more quickly because oral medications do not work.
Q: Who is at Risk for LADA?
A: Sisson says, "epidemiologic studies suggest that there is a higher incidence of LADA in those people with a family history of diabetes. LADA is often diagnosed between the ages of 30-45." He also reports that the jury is still out as to whether there is a link between other autoimmune diseases and LADA. You may find that those persons with existing autoimmune disease are at increased risk of developing LADA, but the research isn't clear.
Q: How Does LADA Present in People?
A: Persons with LADA usually lack central obesity and can be thin. Persons with LADA may also lose weight unexpectedly. Typically, a person with LADA will be diagnosed with Type 2 diabetes because of their age. They are often started on oral diabetes medicines, but because of the underlying autoimmune nature of LADA, the beta cells in the pancreas eventually die and these patients must progress to insulin therapy.
Q: How is LADA Diagnosed?
A: If a person lacks some of the characteristics of Type 2 diabetes, but has a family history of autoimmune disease or diabetes and cannot control their blood sugars with oral medicine, then a physician will run a battery of tests using a blood sample. A blood test is done to see if any antibodies are present, and a measure of C-peptide levels is taken to determine how much insulin is being produced. If there is a low C-peptide level, and high levels of GAD and islet cell antibodies, LADA is diagnosed.
Q: What is a Person's Best Resource for LADA?
A: Sisson suggests that a person with LADA consult with a local diabetes educator by going to www.diabeteseducator.org. He says, "there are many moving parts when it comes to LADA and a certified diabetes educator can help to facilitate a persons' diet, drug therapy strategies, and medication management."
Q: What is the Best Form of Treatment for LADA?
A: Early insulin titration will help to preserve beta cell function. It's also very important to treat the underlying autoimmune issue.
Q: Can a Low Carbohydrate Diet Help to Delay LADA?
A: Sisson says, "taking stress off the pancreas is the best way to preserve beta cell function." A lower carbohydrate means that the pancreas has to work less to make insulin. Diet is certainly important for anyone with any type of diabetes. Although people with LADA may respond to diet and exercise, as well as oral medications, beta cell destruction is inevitable and they will eventually need insulin.
Parkins, Christy. LADA, the Other Diabetes, Can Be Hard to Spot. Diabetes Forecast. Accessed on-line. April 27, 2014.