LADA diabetes

What is LADA or type 1.5 diabetes?

Latent autoimmune diabetes in adults (LADA), also known as type 1.5 diabetes, represents a specific form of diabetes that develops gradually in patients, typically after the age of 30. This condition is characterized by the progressive destruction of the beta cells of the pancreas, responsible for insulin production, due to an autoimmune reaction from the body. Unlike classic type 1 diabetes, which manifests abruptly in children or young adults, LADA progresses more insidiously, which can lead to initial diagnostic errors by healthcare professionals.

Doctors have long considered LADA as a variant of type 2 diabetes, but scientific advances have highlighted its distinctive features. This condition combines elements of type 1 diabetes, notably autoimmunity, with certain characteristics of type 2 diabetes, such as late onset and a slower progression to insulin dependence. According to recent studies, LADA accounts for approximately 10% of diabetes cases diagnosed in adults, making it a relatively common but often misidentified form of diabetes.

Why is LADA different from other types of diabetes?

LADA presents specific characteristics that differentiate it from other types of diabetes.

Comparison with type 1 diabetes

At the onset of the condition, patients affected are generally adults without significant overweight, which differs from the typical profile of juvenile type 1 diabetes. Moreover, the time of diagnosis often reveals a slower progression towards insulin dependency.

Comparison with type 2 diabetes

Unlike type 2 diabetes, the oral medications often prescribed to manage high blood sugar levels are less effective in affected patients. Indeed, these patients generally progress more rapidly towards the need for insulin therapy due to the ongoing destruction of insulin-producing units.

Presence of specific antibodies

An essential characteristic is the presence of specific antibodies directed against pancreatic cells, indicating an immunological origin. These antibodies, particularly anti-GAD (glutamate decarboxylase), are not present in type 2 diabetes. Studies have shown that the detection of these antibodies is crucial for distinguishing it from other forms of diabetes.

According to the American Diabetes Association, it is essential to recognize it as a distinct form to tailor the treatment appropriately.

What causes LADA?

LADA is a complex condition resulting from an interaction between genetic and environmental factors.

Autoimmune mechanisms

Like type 1 diabetes, LADA is caused by an immune reaction where the immune system attacks pancreatic cells. The result is a gradual decrease in the production of insulin, which is essential for regulating blood sugar by allowing organs to use glucose as an energy source.

Genetic and environmental factors

Genetic factors

Genetic predispositions can increase the risk of developing LADA. The genetic similarities between LADA, type 1 diabetes and type 2 diabetes indicate a complex hereditary component.

Environmental factors

Lifestyle factors, including diet and physical activity, can influence the development of LADA. Studies suggest that certain environmental factors, such as early introduction of cow’s milk, gluten, vitamin D deficiency, exposure to viruses, or stress, could trigger an immunological reaction in genetically predisposed individuals.

What are the symptoms of LADA?

Symptoms usually develop gradually. They include:

• High blood sugar leading to excessive thirst and frequent urination.
• Unexplained weight loss despite a normal diet.
• Fatigue and blurred vision.
• Persistent feeling of hunger.
• Frequent infections or slow wound healing.

It is important to consult healthcare professionals as soon as these signs appear. Early detection allows for better management of the condition and reduces the risks of long-term complications, such as cardiovascular disorders or kidney damage.

How to diagnose LADA?

The diagnosis can be complex due to its similarity with type 2 diabetes in adults. Several steps are essential:

• Time of diagnosis: considering the age of the patient and the gradual onset of clinical signs.
• Blood tests to measure high blood sugar and C-peptide levels, an indicator of insulin production.
• Search for specific antibodies, such as anti-GAD, to confirm the autoimmune nature of the disease.
• Analysis of results in collaboration with specialized healthcare professionals.

What is the treatment for LADA?

The management aims to control blood sugar levels and slow the destruction of insulin-producing cells.

• Early insulin therapy: often necessary due to the progressive decrease in insulin production. This approach helps preserve the residual function of secretory units and effectively manage high blood glucose levels.
• Adaptation of lifestyle: a balanced diet rich in fiber, vegetables, and whole grains, while limiting refined sugars and saturated fats.
• Regular practice of physical activity to improve insulin sensitivity and control weight.
• Therapeutic education with the help of professionals to optimize care management.
• Regular monitoring to adjust the treatment based on the progression of the condition.

Oral medications used for type 2 diabetes are generally less effective. Therefore, the rapid introduction of insulin therapy is recommended by the American Diabetes Association to improve glycemic control and delay the progression to total insulin dependence.

Resources like the BETTER registry contribute to enhancing the understanding and management of LADA by collecting data on patients and facilitating research.