ne day last week I participated in a webinar on Latent Autoimmune Diabetes in Adults (LADA). When I worked directly with an Endocrine group, I saw several LADA patents a year. Now, as the CDE for a busy internal medicine clinic, it’s been quite some time that I have seen a person with LADA, so it was a good reminder for me. As opposed to the more rapid onset and early insulin requirement seen in children with type 1 diabetes mellitus (T1DM), LADA is a much more slowly developing autoimmune process. LADA patients may not require insulin for months or years.
That is the major difference between T1DM and LADA - the much slower progression of beta cell destruction in an adult patient. Because of these characteristics, adults are often misdiagnosed at first with type 2 diabetes mellitus (T2DM). These patients may have some insulin resistance included in the mix, adding to the confusion, so that some refer to LADA as Type 1.5 due to the presence of symptoms that resemble T1DM and T2DM.
The webinar discussed that there is still a lot we do not know about LADA such as why some patients need to start taking insulin just a few months after diagnosis while others may be able to control their blood sugars with Metformin for years. It has been only recently, in the last 15 years or so, that we could measure islet cell antibodies, making the diagnosis much easier. In the past, providers would just assume an adult had hard to control T2DM. Now we can establish if there are insulin antibodies or islet cell antibodies present. This allows proper treatment from the beginning. It also provides the patient with increased knowledge of what they are dealing with and what their long term therapy and prognosis might be.
The diagnosis of LADA is something to consider in those adult patients you see that just do not fit the picture of a typical T2DM.
Because of the lack of knowledge about LADA in the general medical community, I have counseled a few of my patients with LADA about the pathophysiology of their disease, emphasizing to them that if they change providers, that they may have to explain to their new provider why they cannot use oral agents to control their blood sugars. The diagnosis of LADA is something to consider in those adult patients you see that just do not fit the picture of a typical T2DM such as no signs of Metabolic Syndrome or really hard to control diabetes with insulin.
There is so much going on in the diabetes arena today – actually there is a LOT going on in medicine, making it increasingly difficult for the non-specialist to stay up to date. We as CDEs need to encourage our patients to learn as much as they can about their disease process and about their particular situation. We need to be advocates in encouraging our patients with diabetes to be participating members of their health care team.
I hope you and your families have a WONDERFUL Holiday season!
About the Author
Barbara Walz is an RN, BSN and has been a certified diabetes educator since 1986. Since 2000, Barbara has coordinated a multi-site diabetes study examining the macro-vascular effects of diabetes at the South Texas Veterans’ Healthcare System under the supervision of Dr. Ralph DeFronzo.