Adult-onset autoimmune diabetes: current knowledge and implications for management

  title={Adult-onset autoimmune diabetes: current knowledge and implications for management},
  author={Raffaella Buzzetti and Simona Zampetti and Ernesto Maddaloni},
  journal={Nature Reviews Endocrinology},
Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult… 

Latent Autoimmune Diabetes in Adults: Current Status and New Horizons

Current knowledge on LADA is summarized, emphasising controversies regarding its pathophysiology and clinical features, and data available about novel therapeutic approaches that can be considered for prevention of β-cell loss in LADA are discussed.

Adult-onset autoimmune diabetes

This Primer by Buzzetti and colleagues summarizes the epidemiology, mechanisms, diagnosis and treatment of this disorder, and summarizes patient quality of life and open research questions.

Adult-onset autoimmune diabetes: comparative analysis of classical and latent presentation

Patients with classic T1DM presented more often with symptoms, lower BMI and higher number of autoantibodies, which may be related to a more aggressive autoimmune process, compared to patients with LADA, which developed more frequently microvascular complications for the same disease duration.

Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management

Since the autoimmune process in LADA seems to be slower than in classical T1DM, there is a wider window for new therapeutic interventions that may slow down β-cell failure.

Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel

The panel concluded by advising general screening for LADA in newly diagnosed non–insulin-requiring diabetes and, importantly, that large randomized clinical trials are warranted.

Current view of diagnosis and treatment of latent autoimmune diabetes in adults.

LADA is characterized by a less intensive autoimmune process, slower progression and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus, and clinical studies suggested also effectivity of other oral antidiabetics enabling preservation of residual β-cell function, such as particularly incretines.

Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes

Improved classification will allow improved assignment of prognosis and therapy as well as an improved cohort in which to analyze and better understand the detailed pathophysiological components acting at onset and during disease progression in late-onset autoimmune diabetes.

Past, present and future of latent autoimmune diabetes in adults

The recent advancements in LADA epidemiology, clinical features, pathogenesis, and interventions are reviewed and the environmental factors that are thought to play an important role in addition to genetics in the pathogenesis of LADA are highlighted.

Etiology and Pathogenesis of Latent Autoimmune Diabetes in Adults (LADA) Compared to Type 2 Diabetes

Data from the limited number of studies on lifestyle factors available indicate that LADA may share several environmental risk factors with type 2 diabetes including overweight, physical inactivity, alcohol consumption (protective) and smoking, suggesting that onset of LADA, similar to type 1 diabetes, to some extent could be prevented or postponed by lifestyle modification such as weight reduction and increased physical activity.

Latent autoimmune diabetes in adults: a focus on β-cell protection and therapy

This review summarizes β-cell function-related heterogeneous factors in LADA, including the age of onset, body mass index, genetic background, and immune, lifestyle, and environmental factors, and evaluates the impact of current hypoglycemic agents and immune intervention therapies for islet β- cell protection.



Latent autoimmune diabetes of the adult: current knowledge and uncertainty

The potential value of screening patients with adult‐onset diabetes for diabetes‐associated autoantibodies to identify those with LADA is emphasized by their lack of clinically distinct features, their different natural history compared with Type 2 diabetes and their potential need for a dedicated management strategy.

Latent autoimmune diabetes in adults (LADA) should be less latent

The nomenclature, diagnostic criteria, genetics, pathology and therapy of LADA are reviewed, to arrive at recommendations that might advance knowledge and management of this form of diabetes.

Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype

The results indicate that adult-onset autoimmune diabetes in Europe encompasses type 1 diabetes and LADA in the same broad clinical and autoantibody-positive spectrum.

Autoimmune diabetes not requiring insulin at diagnosis (latent autoimmune diabetes of the adult): definition, characterization, and potential prevention.

Patients affected by an autoimmune type of diabetes not requiring insulin at diagnosis are defined, also named latent autoimmune diabetes of the adult (LADA), which can serve as a model for designing new strategies for prevention of type 1 diabetes but also as a target group for prevention in its own right.

Autoimmune Aspects of Type 2 Diabetes Mellitus - A Mini-Review

This review focuses on autoimmune involvement in T2DM, with an emphasis on LADA and the humoral immune response, on the involvement of chronic inflammation in autoimmunity, and specifically the role of B and T cells as links between inflammatory and autoimmune reactions.

β-Cell Protection and Therapy for Latent Autoimmune Diabetes in Adults

Uncertainties concern almost all aspects of this disease, including the nomenclature, diagnostic criteria, epidemiology, natural history, and pathogenesis with genetic, metabolical, and immunological aspects.

Latent autoimmune diabetes in adults: definition, prevalence, beta-cell function, and treatment.

Latent autoimmune diabetes in adults (LADA) is a disorder in which, despite the presence of islet antibodies at diagnosis of diabetes, the progression of autoimmune beta-cell failure is slow. LADA

LADA and CARDS: A Prospective Study of Clinical Outcome in Established Adult-Onset Autoimmune Diabetes

Adult-onset autoimmune diabetes was prevalent, even in patients with established diabetes presumed to have type 2 diabetes, and the frequency of microvascular and macrovascular events was similar in both cohorts, independent of atorvastatin.

Latent Autoimmune Diabetes in Adults Differs Genetically From Classical Type 1 Diabetes Diagnosed After the Age of 35 Years

LADA patients differed genetically and phenotypically from both T1D>35y and type 2 diabetic patients in a manner dependent on GADA levels, but even the highest quartile differed from type 1 diabetes.

Diabetes at the crossroads: relevance of disease classification to pathophysiology and treatment

The evidence is discussed that autoimmune type 1 diabetes has a broad clinical phenotype with diverse therapeutic options, while the term non-autoimmune type 2 diabetes obscures the optimal management strategy because it encompasses substantial heterogeneity.