Regarding screening for LADA, no definite recommendations can be done at this time because of lack of enough evidence coming from clinical trials (e.g., no cost-benefit assessment has been performed).
It is possible that in the disease course there are differences in the antigenic repertoire triggering immune responses, frequency of autoreactive immune cells, and/or the degree of immune regulation, but these aspects still need to be investigated. The differences between the two forms may be due to genetic factors (e.g., presence of protective HLA alleles in LADA) and/or due to qualitative/quantitative dissimilarities in the interaction with environment. In addition, the natural history of the disease, the timing of the diagnosis in relation to it, as well as clinical features at diagnosis (e.g., presence or absence of symptoms) are factors that influence the period of insulin independence ( 1).Įven though the question regarding pathogenesis of LADA is still not fully answered, it is clear now that there are strong genetic and immunologic similarities to type 1 diabetes, implying that LADA is an autoimmune disease. This criterion is used to distinguish LADA patients from those with type 1 diabetes, but reports indicate that there is a high bias in the time to insulin treatment initiation and it does not depend on disease process, but rather on physicians' clinical judgment ( 9). Even though ∼10% of adults with presumed type 2 diabetes at diagnosis in fact have LADA, only a few studies so far have evaluated therapeutic interventions for LADA, using a hypoglycemic or an immunomodulatory agent.Ĭriterion 3: lack of insulin requirement for at least 6 months after diagnosis
An ideal therapeutic approach would aim not only at obtaining a good metabolic control, but also at protecting residual β-cell mass and function. As a consequence, there is no clear management strategy for it, in terms of therapy and prevention. Uncertainties concern almost all aspects of this disease, including the nomenclature, diagnostic criteria, epidemiology, natural history, and pathogenesis with genetic, metabolical, and immunological aspects. It was even debated whether LADA exists as a distinct disease entity or it just represents the end of a wide spectrum of heterogeneous immune-mediated diabetes ( 2, 3). But LADA still remains poorly understood and defined ( 1). Controversies have been surrounding this concept and several attempts have been made to better characterize and classify it. Latent autoimmune diabetes in adults (LADA) is a term used to describe a form of autoimmune diabetes that resembles type 1 diabetes, but has a later onset and slower progression toward an absolute insulin requirement.
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