Latent autoimmune diabetes in adults: a guide for the perplexed

Genetic Similarities Between Latent Autoimmune Diabetes and Type 1 and Type 2 Diabetes

“…LADA has been defined as the presence of GAD antibodies in patients with age of onset of diabetes after 35 years and insulin independence for at least 6 months after diagnosis (4 -6). We agree with the authors in abandoning the standard definition of LADA and would agree with a number of other reviews that suggest one should abandon the term LADA altogether (7,8). A simpler alternative would be islet autoantibody-positive diabetes, which would likely come close to equating with type 1A diabetes, depending upon the specificity of the assays used.…”

Latent autoimmune diabetes in adults (LADA)—more than a name

“…Beta cell function deteriorates faster than in type 2 diabetes but slower than in type 1 diabetes [1,5,13,16], and there is no difference in hepatic or peripheral insulin sensitivity between type 1, type 2 and LADA, whether in the diabetic [3] or the prediabetic [17] state. Nevertheless, patients with LADA have fewer features of the metabolic syndrome than patients with type 2 diabetes [6,18], and have fewer macrovascular complications [18].…”

“…We think that LADA is needed as an entity to foster research on these topics and provide more precise answers to the questions raised [1,2]. Defining a multifactorial disease is a notoriously difficult [11], but in contrast to Gale, we do think that it will become possible to define LADA in a clinically meaningful way that should also provide aetiological information.…”

“…In a recent editorial [1], Edwin Gale questioned the rationale for the designation of latent autoimmune diabetes in adults (LADA) [2] as a distinct aetiological entity. The reasons given for this were that measurements of antibodies to GAD are imprecise and cut-off levels are arbitrary, and that the clinical value of a diagnosis of LADA has not been demonstrated.…”

Comment on: Gale EAM (2005) Latent autoimmune diabetes in adults: a guide for the perplexed. Diabetologia 48:2195–2199

“…To the Editor: The editorial, 'Latent autoimmune diabetes in adults: a guide for the perplexed' [1] questions the need for the separate classification of autoimmune diabetes developing in adults (latent autoimmune diabetes in adults [LADA]) from the disease developing in childhood (type 1 diabetes). In it Edwin Gale concludes that the evidence is marginal for designation of LADA as a distinct aetiological entity in the burgeoning world of subdivisions of diabetes.…”