Diagnostic Criteria of Latent Autoimmune Diabetes in Adults (LADA)

Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas but patients eventually become insulin dependent more rapidly than with type II DM patients.

Diagnostic Criteria of Latent Autoimmune Diabetes in Adults (LADA)
To discriminates LADA from type I and/or type II DM, diagnosis of LADA has been based on three criteria as given by The Immunology of Diabetes Society:

  1. Adult age of onset (> 30 years of age);
  2. Presence of at least one circulating autoantibodies (GADA/ICA/IAA/IA-2); and
  3. Initial insulin independence (for the first six months).

In a retrospective study by Fourlanos et al, five clinical parameters were found to be more frequent in LADA than in type II DM:

  1. Age of onset < 50 years;
  2. Acute symptoms (polyuria/polydypsia/weight loss);
  3. BMI < 25 kg/m2
  4. Personal history of other autoimmune diseases; and
  5. Family history of autoimmune disease.

Other workers have also reported a lower BMI, waist/hip ratio, total cholesterol and triglycerides levels and higher HDL-CH in LADA than in patients with type II DM. The prevalence of hypertension was also lower in LADA patients.
Abbreviations:

  • LADA: Latent Autoimmune Diabetes in Adults;
  • GADA: Anti Glutamic Acid Decarboxylase Antibodies;
  • ICA: islet cell antibody;
  • IAA: insulin autoantibody;
  • IA2: antibodies: AntiTyrosine Phosphatase IA2 Antibodies;
  • BMI: Body Mass Index;
  • HLA: Human Leukocyte Antigen

 
 
References:

  1. Nambam B, Aggarwal S, Jain A. Latent autoimmune diabetes in adults: A distinct but heterogeneous clinical entity. World J Diabetes. 2010 Sep 15;1(4):111-5. [Medline]
  2. Laugesen E, Østergaard JA, Leslie RD; Danish Diabetes Academy Workshop and Workshop Speakers. Latent autoimmune diabetes of the adult: current knowledge and uncertainty. Diabet Med. 2015 Jul;32(7):843-52. [Medline]
  3. Liao Y, Xiang Y, Zhou Z. Diagnostic criteria of latent autoimmune diabetes in adults (LADA): a review and reflection. Front Med. 2012 Sep;6(3):243-7. [Medline]
  4. Fourlanos S, Perry C, Stein MS, Stankovich J, Harrison LC, Colman PG. A clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care. 2006 May;29(5):970-5. [Medline]

Created Jan 25, 2017.

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