Introduction
Diabetes mellitus (DM) is a group of metabolic diseases characterized by chronic hyperglycemia, which is the result of a violation of insulin secretion, the effects of insulin, or both of these factors. Chronic hyperglycemia in diabetes is accompanied by damage, dysfunction, and insufficiency of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels. LADA is latent autoimmune diabetes in adults, the symptoms and initial course of which are consistent with the clinical picture of diabetes 2, but the etiology is closer to diabetes 1. However, a LADA analysis shows that this is a soft edge of the spectrum of manifestations of diabetes 1, because it is autoimmune, high GAD titer, and small doses of insulin can be prescribed.
Characteristics
The patients in adulthood and with long-term diabetes diagnosed with type 2 diabetes, in which the onset of symptoms was not accompanied by ketosis and did not require the use of insulin therapy. During the examination, it was found that patients had a low level of C-peptide in response to stimulation by glucagon, which indicated that they had an absolute deficit in insulin secretion (Buzzetti, Pozzilli, Frederich, Iqbal, & Hirshberg, 2016). Of no small importance was the fact that in the majority of patients with diabetes mellitus with insulin deficiency GAD was detected, which are a marker of autoimmune insulin, and among patients with diabetes without insulin deficiency, these antibodies were found only in rare cases.
Categories
The term latent autoimmune adult diabetes (LADA) was proposed to describe a group of patients who had clinical manifestations of type 2 diabetes, positive antibodies top-cell components, and when the disease manifested, there was no ketoacidosis and weight loss. With LADA, GAD, and antibodies to the β cells of the pancreas are detected. It is estimated that in different populations, from the minimum to half of the patients diagnosed with type 2 diabetes, LADA is actually affected.
LADA can be classified into type 1 and type 2, depending on the GAD titer (Castelblanco et al., 2018). Patients with a high GAD titer having phenotypic similarities to type 1 diabetes, such as ketoacidosis, lower levels of C-peptide, BMI, and insulin resistance, are type 1 LADA. Patients with a lower GAD titer having phenotypic similarities as type 2 diabetes, such as higher levels of C-peptide, BMI, and insulin resistance, are classified as patients with LADA type 2.
Treatment
Currently, one of the main directions of modern research on LADA is the problem of preventing the development of insulin deficiency. Based on the results of many years of research, it was concluded that it is advisable to prescribe insulin injections in small doses to patients with LADA in order to prevent the development of insulin deficiency in them (Wod et al., 2018). Thus, the appointment of an intensified insulin therapy regimen protects ß cells from destruction and prolongs the endogenous secretion of insulin, which facilitates the maintenance of glycemia at the proper level, reduces the risk of hypoglycemia, and prevents the early development of complications of diabetes.
Conclusion
In conclusion, LADA is a disease pathogenetically caused by autoimmune damage to the cells of the islet apparatus of the pancreas, characterized by a slowly progressing course with the final development of insulin deficiency. The presence of an immunological marker for an autoimmune disease, namely GAD, is the main criterion for the diagnosis of LADA. Given the evidence of the presence of LADA type 2, the identification of patients with LADA among patients with type 2 diabetes is necessary for the earlier appointment of insulin therapy in order to prevent the development of insulin deficiency.
References
Buzzetti, R., Pozzilli, P., Frederich, R., Iqbal, N., & Hirshberg, B. (2016). Saxagliptin improves glycaemic control and C‐peptide secretion in latent autoimmune diabetes in adults (LADA). Diabetes Metabolism Research and Reviews, 32(3), 289-296.
Castelblanco, E., Hernandez, M., Castelblanco, A., Gratacos, M., Esquerda, A., Mollo, A., … Mauricio, D. (2018). Low-grade inflammatory marker profile may help to differentiate patients with LADA, classic adult-onset type 1 diabetes, and type 2 diabetes. Diabetes Care, 41(4), 862-868.
Wod, M., Thomsen, R. W., Pedersen, L., Yherstraede, K. B., Beck-Njelsen, H., & Hojlund, K. (2018). Lower mortality and cardiovascular event rates in patients with Latent Autoimmune Diabetes in Adults (LADA) as compared with type 2 diabetes and insulin deficient diabetes: A cohort study of 4368 patients. Diabetes Research and Clinical Practice, 139(2), 107-113.