Adult-onset Autoimmune Diabetes: how to Diagnose and Tackle it
Latent Autoimmune Diabetes in Adults (LADA) is a form of slowly-progressive autoimmune diabetes with onset after the age of 30 years. Few is known about this particular form of diabetes, which does not require insulin treatment for at least 6 months after the diagnosis. LADA is too often wrongly diagnosed as type 2 diabetes because it is initially characterized by a lower impairment of glucose metabolism compared to classic type 1 diabetes.
Epidemiological studies conducted in the last ten years showed that the prevalence of this form of diabetes is comparable to that of juvenile type 1 diabetes.
A team of researchers from the Department of Experimental Medicine of Sapienza University of Rome, headed by Raffaella Buzzetti, together with the Department of Medicine, Unit of Endocrinology and Diabetes, of Campus Bio-Medico University, investigated and described the most appropriate treatment strategies for both early and late stages of LADA. Results of this work have been recently published in the eminent scientific journal Nature Reviews, Endocrinology.
“Without specific guidelines for this form of diabetes – Raffaella Buzzetti explains – we have tried to provide a panel of possible management strategies to be adapted to the different and heterogeneous cases of LADA”.
LADA heterogeneity was previously shown by the NIRAD (Non-Insulin Requiring Adult-onset Diabetes) study.
This study enrolled 5000 subjects in 84 centres from all over Italy, significantly contributing to the advancements in knowledge about this disease. In particular, researchers from Sapienza University of Rome hypothesize that LADA heterogeneity is due to different pathogenic mechanisms such as different degrees of insulin resistance and autoimmunity.
This makes it difficult to define a priori generalizable treatment strategies, highlighting the need for personalized therapies. In this regard, the paper by Buzzetti et al. is among the most relevant for the dissemination of knowledge on epidemiology, pathophysiology and prevalence of complications, improving the possibilities for physicians to make an early diagnosis and an appropriate treatment.
Raffaella Buzzetti (1), Simona Zampetti(1) and Ernesto Maddaloni(2)
(1)Department of Experimental Medicine, Sapienza University, Viale Regina Elena 324, 00161 Rome, Italy.
(2)Department of Medicine, Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Via Álvaro del Portillo 21, 00128 Rome, Italy.
Adult-onset autoimmune diabetes: current knowledge and implications for management. Nature Reviews Endocrinology (2017) DOI:10.1038/nrendo.2017.99 Published online 08 September 2017