Latent Autoimmune Diabetes in Adults (LADA) or type 1.5 diabetes


What is Latent autoimmune diabetes in adults?

Latent Autoimmune Diabetes in Adulthood or LADA is commonly known as diabetes 1.5. This is because it is a subtype of type 1 diabetes but with features of type 2 diabetes.

The fact that  LADA is a mix of the popularly known type 1 and type 2 diabetes, is what makes it hard to diagnose. Most of the time, since type 2 diabetes is the most prevalent, even though a patient may suffer from LADA, they could be diagnosed with type 2 diabetes.

It is estimated that about 10-25% of the people diagnosed with type 2 diabetes, unrelated to obesity, might actually have LADA. 

Let’s look at the causes of type 1 and type 2 diabetes to understand why LADA is so commonly misdiagnosed:

Type 1 diabetes – 

  1. Occurs at a younger age
  2. Shows rapid onset
  3. Autoimmune

Type 2 diabetes –

  1. Occurs at a later age
  2. Shows gradual onset
  3. Characterised by insulin resistance

LADA on the other hand, is a blend of the components causing both type 1 and type 2 diabetes –

  1. Like type 1 diabetes, LADA is caused by an autoimmune attack on the beta cells of the pancreas which affects the body’s ability to produce insulin.
  2. Like type 2 diabetes, it affects patients in their later age and has a gradual onset or progression. This gradual onset starting in patients who are in their 40s or 50s as compared to childhood or teenage makes it very similar to the most common – type 2 diabetes.

Symptoms of Latent Autoimmune Diabetes in Adults (LADA) or type 1.5 diabetes

Just like type 1 and type 2 diabetes, LADA is asymptomatic. It is hence ideal for getting diagnosed in the initial stage of the disease for better regulation through regular blood-check up.

However, if the glucose levels are very high in the blood, it may manifest into symptoms like

  1. Unintentional weight loss
  2. Frequent thirst
  3. Constant hunger
  4. Frequent urination

How to know if you could have LADA?

  • If you’re an adult over 40 who’s diagnosed with diabetes which is unrelated to obesity i.e if a person in their 40s or 50s is diagnosed with diabetes but they’re slimmer rather than heavier, it could be an indication of LADA.
  • Since LADA is an autoimmune condition, if you’re already suffering from other autoimmune disorders like Grave’s or Addison’s disease, thyroid or Rheumatoid arthritis then you could have LADA.
  • If autoimmune disorders run in the family, you run a higher risk of being diagnosed with LADA.
  • If a person who’s diagnosed with type 2 diabetes but requires insulin much earlier say within a couple of years of diagnosis than when it’s usually administered in treatment for type 2, it could indicate LADA because people of type 2 often don’t need insulin and even if they do, it is in the later stages of treatment.

Testing for LADA –

Since type 1 diabetes and LADA are autoimmune in nature, the body produces antibodies in both cases. Thus, if antibodies are present in the blood, this could mean that the person is suffering from LADA. The antibody usually involved in LADA is the GAD65 auto-antibody. So, the most common test for LADA includes testing for the GAD65 Antibody. If you run a risk of LADA, you could be tested for

  1. GAD65 Antibody
  2. Autoimmune Diabetes Panel
  3. C-peptide 

It is important to get the right testing and diagnosis since it determines the proper treatment.

Following the guidelines of the International Classification of Diseases (ICD), patients with LADA are assigned the ICD-10-CM code recognising diabetes 1.5 type by healthcare providers for effective diagnostic coding and better data for quality measurement, to keep a record owing to the fast-paced medical advancements.

Treatment for LADA or type 1.5 diabetes –

  1. Insulin replacement is always necessary
  2. Certain medications like DPP-4 and GLP-1 may help for years when administered in the early stages when beta cells have not fully lost their function of insulin production.
  3. Metformin medication can be useful for increasing insulin sensitivity in those who are obese because they might develop insulin resistance in addition to the autoimmune attack on beta cells.
  4. Sulfonylureas can lower blood glucose initially but can also degenerate the beta cells much more quickly. So, it is best to avoid sulfonylureas in treating LADA.

Commonly practiced best and sought-after treatment for LADA includes early insulin administration to prevent further damage of beta cells by the immune system.

Your role in managing Latent Autoimmune Diabetes in Adults (LADA) or type 1.5 diabetes –

Although medication and insulin administration may enhance the ability to fight against LADA, like every type of diabetes, it is crucial to develop healthy lifestyle habits for effective management of the disease and preventing complications like stroke, kidney disorders, blindness, and reduced immunity which lower the life expectancy and increase the risk of mortality. In diseases like LADA, It is very important to consult a diabetic specialist for the right diagnosis to get the proper treatment that rightfully addresses the cause.

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