Net Guide: Latent Autoimmune Diabetes

MDNG Endocrinology, June 2010, Volume 12, Issue 4

We searched the Internet for LADA resources so you don't have to.

//Medical Websites

LADA Action

Use this site to follow the progress of a nine-nation European study that seeks “to define the prevalence of LADA in different European countries by screening 10,000 adult patients with recently diagnosed non-insulin requiring diabetes with the hope of obtaining 1000 patients with LADA.” Researchers will attempt “to characterise genetic, immunological, and metabolic features of patients affected by LADA,” and administer DiaPep227 in a double-blind trial comprising “350 LADA patients with defined positivity for autoantibodies to glutamic acid decarboxylase and islet cell antibodies but who are initially non insulin requiring.”

Link Code: e12412

//The Educated Patient™

The Other Diabetes: LADA,or Type 1.5

Diabetes Forecast featured this highlyaccessible article on LADA in its May 2010 issue. It does an excellent job of explaining the science and history behind the disease without being overly technical, while at the same time emphasizing to at-risk patients the importance of being tested for this specific type of diabetes. At the end of the article, readers will find a link to a complementary story about yet another relatively unknown type of diabetes: maturity-onset diabetes of the young.

Link Code: e12427

Diabetes Information — Latent Autoimmune Diabetes in Adults

Because of the age of onset, LADA is often misdiagnosed, initially, as type 2 diabetes. This website, put together by the Islets of Hope organization, differentiates the two illnesses with a thorough description of each and a chart that highlights a characteristic of diabetes—such as genes, triggers, and contributing factors—and explains how these characteristics are different among individuals with each type of diabetes. Other components of the site, such as treatment options, daily medical concerns, long-term complications, and prognosis, will provide patients with the skills and medical knowledge to actively participate in the management of LADA.

Link Code: e12428

Type Free Diabetes: LADA

This site features three main categories of information: explanations of how LADA differs from type 2 diabetes, characteristics of adults with LADA, and treatment for the condition. The listing of the disease’s characteristics will help patients understand, in more detail, the symptoms they may be affected by, and also serve as a way for their loved ones to monitor their health if they are concerned about LADA. In addition to written explanations of the disease, the site also features fully detailed images of the organs, hormones, and cells involved in LADA.

Link Code: e12429

10 Facts about Latent Autoimmune Diabetes

This is not an in-depth resource, but it can be useful as a printed hand-out at the time of diagnosis. The article covers the disease’s other names, antibodies, insulin dependency, insulin resistance, classification, family history, appearance, age at diagnosis, treatment, and complications.

Link Code: e124211

Diabetes Education Online: Type 1 Diabetes

Type 1 Diabetes Included in this type 1 diabetes primer, produced by the Diabetes Teaching Center at the University of California, San Francisco, is an explanation of the three sub-categories of type 1 diabetes (type 1a, type 1b, LADA) and how it is determined into which type of diabetes a patient has.

Link Code: e124210

//eAbstracts

Clinical and Metabolic Characteristics of Patients with Latent Autoimmune Diabetes in Adults: Absence of Rapid Beta-cell Loss in Patients with Tight Metabolic Control

Journal: Diabetes and Metabolism (February 2010)

Authors: Chaillous L, Bouhanick B, Kerlan V, et al.

Purpose: To compare the clinical and metabolic characteristics of LADA with those of type 2 diabetes.

Results: Patients with LADA demonstrated lower residual beta-cell function than individuals with type 2 diabetes, although “those who achieve tight metabolic control do not present with a rapid decline in beta-cell function.” In regard to these patients, the researchers suggest that more research be done “to determine the optimal treatment strategy in such patients.”

Link Code: e12455

Latent Autoimmune Diabetes in Adults: A Case ReportJournal: American Journal of Therapeutics (May/June 2010)

Authors: Bermúdez V, Aparicio D, Colmenares C, et al.

Purpose: To review the clinical case of a 23-year-old male diagnosed with type 2 diabetes since six months of age and then later diagnosed with LADA.

Results: Although there were no pathologic findings during the physical exam, “anthropometry and laboratory test results were as follows: body mass index (BMI) = 19.66 kg/m2, basal and postprandial glycemia = 108, and 276 mg/dL respectively, glycated haemoglobin = 8.9%, basal and postprandial Cpeptide (2 hours) = 1.9, and 3.2 ng/mL, homeostasis model assessment of beta cell function: 87.5%, homeostasis model assessment of insulin resistance: 1.6.” The presumed diagnosis of LADA was later confirmed through the presence of autoantibodies anti-tyrosin-phosphatase and GAD65.

Link Code: e12456

Altered Natural Killer Cell Frequency and Phenotype in Latent Autoimmune Diabetes in Adults Prior to Insulin DeficiencyJournal: Clinical & Experimental Immunology (April 9, 2010)

Authors: Akesson C, Uvebrant K, Oderup C, et al.

Purpose: Because “a decrease in the frequency of peripheral blood natural killer (NK) cells has been reported recently in recent-onset type 1 diabetes and in high-risk individuals prior to the clinical onset,” and “NK cells in LADA patients have been investigated scarcely,” researchers used “multicolour flow cytometry to define possible deficiencies or abnormalities in the frequency or activation state of NK cells in LADA patients prior to insulin dependency.”

Results: Certain observations—1) “all patients were glutamic acid decarboxylase 65 autoantibody-positive and metabolically compensated, but none were insulin-dependent at the time blood samples were taken;” 2) “LADA patients exhibited a significant decrease in NK cell frequency in peripheral blood compared to healthy individuals (P = 0.0018), as reported previously for recentonset T1D patients;” 3) “NKG2D expression was increased significantly (P < 0.0001), whereas killer cell immunoglobulin-like receptor (KIR)3DL1 expression was decreased (P < 0.0001) within the NK cell population”—“highlight a defect in both frequency and activation status of NK cells in LADA patients and suggest that this immunological alteration may contribute to the development of autoimmune diabetes by affecting peripheral tolerance.”

Link Code: e12457

From the Network

LADA: A Little Known Type of Diabetes

In recent years, researchers have discovered another form of diabetes, referred to as latent autoimmune

diabetes in adults. Some other names for LADA include diabetes type 1.5, slow-progressing

type 1 diabetes, and late-onset autoimmune diabetes. Although different names have caused confusion,

they all refer to a subset of patients with type 2 diabetes who have antibodies and genetic factors

commonly found in those with type 1 diabetes.

www.pharmacytimes.com/issue/pharmacy/2009/october2009/FeatureFocusLADA-1009

Pharma Focus

Diabetes Medications

Insulin LisproBrand Name: Humalog

Type: Insulin analog, 100 U/mL (injectable; subcutaneous)

Indication: For use by type 1 and type 2 diabetics who use insulin

http://pi.lilly.com/us/humalog-pen-pi.pdf

PramlintideBrand Name: Symlin

Type: Amylin analog, 100 U/mL (injectable; subcutaneous)

Indication: For use by type 1 and type 2 diabetics who use insulin

www.symlin.com/170-important-safety-information.aspx

Insulin AspartBrand Name: NovoLog

Type: Insulin analog, 100 U/mL (injectable; subcutaneous)

Indication: For use by type 1 and type 2 diabetics who use insulin

www.novolog.com/NovoLog_Prescribing_Info.pdf

Insulin Glulisine

Brand Name: Apidra

Type: Insulin analog, 100 U/mL (injectable; IV [infusion], subcutaneous)

Indication: For use by type 1 and type 2 diabetics who use insulin

www.apidra.com/hcp/default.aspx