Knowledge about LATENT AUTOIMMUNE DIABETES IN ADULTS (LADA), a form of diabetes that occurs when the immune system mistakenly attacks insulin-producing cells in the pancreas, is crucial for fostering awareness and ensuring timely interventions for better health outcomes.
In an interview with THIP Media, Dr Anupam Dey, a distinguished medicine specialist and diabetologist currently affiliated with Tulip Care Hospitals in Cuttack, helps navigate its complexities.
What exactly is latent autoimmune diabetes in adults, and how does it differ from type 1 and type 2 diabetes?
Latent autoimmune diabetes in adults is actually a mixture of both type 1 and type 2 diabetes. That is why it is also called type 1.5 diabetes. It is believed to be an autoimmune condition, similar to type 1, but the diagnosis usually comes late in adulthood and progresses gradually, which resembles type 2 diabetes. It is typically diagnosed initially as type 2 diabetes and later recognized as LADA. It has been known for quite some time, but we are only now understanding its complexities. It shares similarities with both types, but it is a distinct form of diabetes, which is why confusion arises.
Are there any risk factors associated with the development of LADA?
LADA is a hybrid condition primarily caused by autoantibodies formed against the insulin-secreting beta cells of the pancreas. The tendency arises from insulin resistance. The risk factors are similar to those for type 2 diabetes, such as obesity, smoking, alcohol, and dietary factors. Lifestyle factors remain the same.
Another important factor is family history of autoimmune diseases, which can sensitize an individual to develop LADA. Environmental toxins and viral infections can also trigger autoimmune responses. Variants in the HLA gene may also contribute.
What are the common signs and symptoms of LADA? How can individuals distinguish it from other forms of diabetes, especially in the early stages?
The signs and symptoms are similar to type 2 diabetes: frequent urination, excessive thirst, excessive weight loss despite normal appetite, fatigue, blurred vision, lethargy, and slow wound healing. These usually bring a patient to the doctor suspecting diabetes.
What helps identify LADA is a progressively uncontrolled sugar pattern despite starting oral hypoglycemics. Fasting sugars may rise above 270 mg/dL, and the patient usually has a lower BMI, which differs from typical type 2 diabetes. If someone above 30 has rising sugars despite good diet and lifestyle control and has a lower BMI, LADA should be suspected. This should trigger testing for LADA.
What diagnostic tests are used to confirm LADA, especially when it is misdiagnosed as type 2 diabetes?
According to ADA 2025 guidelines, if someone is above 30, has a lower BMI, and shows increasing sugars despite proper lifestyle management, screening for LADA is recommended. The main antibody is the glutamic acid decarboxylase antibody (GADA). Testing for GADA is available. If titers are high, it indicates LADA.
We then check C-peptide levels to determine treatment options based on the level of insulin production.
How is LADA medically managed? Are treatment options similar to insulin therapy, lifestyle changes, or medications?
Treatment depends on C-peptide levels.
- If C-peptide is less than 0.3, we start multiple insulin therapy as in type 1 diabetes.
- If it is between 0.3 and 0.7, we use both insulin and antidiabetic medications and monitor progress, as the disease gradually worsens.
- If it is above 0.7, we may start oral antidiabetics with careful monitoring.
Does work-related stress impact the onset or progression of this condition? What stress-management strategies would you recommend?
Yes, work-related stress has a direct relationship with the development of LADA. A recent study showed that 55% of individuals in India experience work-related stress. Increased stress raises cortisol levels, which increases insulin resistance and damages beta cells—the basis of LADA.
Managing stress is crucial. Strategies include maintaining good sleep hygiene, regulating circadian rhythm, fixed sleep and wake times, and ensuring sufficient sleep. Time management is important. Working in small capsules or spurts with breaks helps prevent overstress.
Maintaining family time, fixed meal timings, and avoiding delays in meals are important. Regular exercise and yoga also help. Without proper stress management, LADA becomes uncontrolled.
If LADA is not managed properly, does it affect other organs such as the heart, kidneys, or eyes?
Yes. Like other forms of diabetes, LADA affects the heart, kidneys, and eyes, causing microvascular and macrovascular complications. In its most dangerous period, LADA can cause more harm due to direct endothelial injury of blood vessels. Insulin resistance and beta-cell damage contribute to this. Rising hyperglycemia, oxidative stress, and insulin resistance have a significant impact on the heart, kidneys, and eyes, leading to complications such as diabetic retinopathy.
What role does health literacy play in preventing and managing LADA? How can awareness help individuals recognize symptoms early and seek appropriate care?
Health literacy plays a major role. There is confusion about this type of diabetes because people only know type 1 and type 2. LADA adds complexity. People need to understand autoantibodies and how they damage beta cells. Awareness helps individuals recognize that if they are over 30, in good health, yet have worsening sugars, they should consider LADA and consult a doctor.
Awareness through social media, talks, and general discussion is essential. LADA can cause more complications than type 2 and often eventually requires insulin. Patients frequently question why they shift from oral drugs to insulin. Awareness prepares them for this change and helps manage the disease properly.
What advice would you give patients at risk of LADA or those who have already developed it to reduce their chances of developing or worsening the condition?
The best advice is awareness. People must know that this condition can develop after 30 and should visit the doctor regularly. Regular diabetes care and monitoring sugar patterns are essential. Lifestyle modifications are crucial, as LADA cannot be controlled without them. Stress management at work is also vital. If one person becomes educated, awareness spreads in the workplace. Understanding that LADA can occur in anyone above 30 is important.
Hence, studying sugar patterns, adopting healthy lifestyle choices, and managing stress appropriately are key.
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