Skip to main content
Log in

Latent (slowly progressing) autoimmune diabetes in adults

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

About 10% of patients with the clinical presentation of type 2 diabetes suffer from an autoimmune form of diabetes associated with a rapid decline of residual β-cell mass and subsequent development of insulin dependency. In this condition, called latent autoimmune diabetes in adults (LADA), there are clinical and metabolic features intermediate between type 1 and type 2 diabetes. Recent studies provide novel information on the immune markers associated with progressive β-cell loss in LADA patients. However, LADA pathogenesis is still poorly understood; further studies are needed to establish general recommendation for preventing and treating this subtype of autoimmune diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus [no authors listed]. Diabetes Care 1997, 26:S5–S20.

  2. Notkins AL, Lernmark A: Autoimmune type 1 diabetes: resolved and unresolved issues. J Clin Invest 2001, 108:1247–1252.

    PubMed  CAS  Google Scholar 

  3. Peng H, Hagopian W: Environmental factors in the development of type 1 diabetes. Rev Endocr Metab Disord 2006, 7:149–162.

    Article  PubMed  Google Scholar 

  4. Pihoker C, Gilliam LK, Hampe CS, Lernmark A: Autoantibodies in diabetes. Diabetes 2005, 54(Suppl 2):S52–S61.

    Article  PubMed  Google Scholar 

  5. Wenzlau JM, Juhl K, Yu L, et al.: The cation efflux transporter ZnT8 (Slc30A8) is a major autoantigen in human type 1 diabetes. Proc Natl Acad Sci U S A 2007, 104:17040–17045.

    Article  PubMed  CAS  Google Scholar 

  6. Yang Y, Santamaria P: Lessons on autoimmune diabetes from animal models. Clin Sci 2006, 110:627–639.

    Article  PubMed  Google Scholar 

  7. Peakman M, Tree TI, Endl J, et al.: Characterization of preparations of GAD65, proinsulin, and the islet tyrosine phosphatase IA-2 for use in detection of autoreactive T-cells in type 1 diabetes: report of phase II of the Second International Immunology of Diabetes Society Workshop for Standardization of T-cell assays in type 1 diabetes. Diabetes 2001, 50:1749–1754.

    Article  PubMed  CAS  Google Scholar 

  8. Di Lorenzo TP, Peakman M, Roep BO: Translational mini-review series on type 1 diabetes: systematic analysis of T cell epitopes in autoimmune diabetes. Clin Exp Immunol 2007, 148:1–16.

    PubMed  Google Scholar 

  9. Verge CF, Gianani R, Kawasaki E, et al.: Prediction of type I diabetes in first-degree relatives using a combination of insulin, GAD, and ICA512bdc/IA-2 autoantibodies. Diabetes 1996, 45:926–933.

    Article  PubMed  CAS  Google Scholar 

  10. Bingley PJ, Bonifacio E, Williams AJ, et al.: Prediction of IDDM in the general population: strategies based on combinations of autoantibody markers. Diabetes 1997, 46:1701–1710.

    Article  PubMed  CAS  Google Scholar 

  11. Achenbach P, Koczwara K, Knopff A, et al.: Mature high-affinity immune responses to (pro)insulin anticipate the autoimmune cascade that leads to type 1 diabetes. J Clin Invest 2004, 114:589–597.

    PubMed  CAS  Google Scholar 

  12. Barker JM, Barriga KJ, Yu L, et al.: Prediction of auto-antibody positivity and progression to type 1 diabetes: Diabetes Autoimmunity Study in the Young (DAISY). J Clin Endocrinol Metab 2004, 89:3896–3902.

    Article  PubMed  CAS  Google Scholar 

  13. Achenbach P, Warncke K, Reiter J, et al.: Stratification of type 1 diabetes risk on the basis of islet autoantibody characteristics. Diabetes 2004, 53:384–392.

    Article  PubMed  CAS  Google Scholar 

  14. Niskanen LK, Tuomi T, Karjalainen J, et al.: GAD antibodies in NIDDM. Ten-year follow-up from the diagnosis. Diabetes Care 1995, 18:1557–1565.

    Article  PubMed  CAS  Google Scholar 

  15. Turner R, Stratton I, Horton V, et al.: Autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes. U.K. Prospective Diabetes Study Group. Lancet 1997, 350:1288–1293.

    Article  PubMed  CAS  Google Scholar 

  16. Seissler J, DeSonnaville JJJ, Morgenthaler NG, et al.: Immunological heterogeneity in type 1 diabetes: presence of distinct autoantibody patterns in patients with acute onset and slowly progressive disease. Diabetologia 1998, 41:891–897.

    Article  PubMed  CAS  Google Scholar 

  17. Tuomi T, Carlsson A, Li H, et al.: Clinical and genetic characteristics of type 2 diabetes with and without GAD antibodies. Diabetes 1999, 48:150–157.

    Article  PubMed  CAS  Google Scholar 

  18. Lohmann T, Kellner K, Verlohren HJ, et al.: Titre and combination of ICA and autoantibodies to glutamic acid decarboxylase discriminate two clinically distinct types of latent autoimmune diabetes in adults (LADA). Diabetologia 2001, 44:1005–1010.

    Article  PubMed  CAS  Google Scholar 

  19. Falorni A, Gambelunghe G, Forini F, et al.: Autoantibody recognition of COOH-terminal epitopes of GAD65 marks the risk for insulin requirement in adult-onset diabetes mellitus. J Clin Endocrinol Metab 2000, 85:309–316.

    Article  PubMed  CAS  Google Scholar 

  20. Zinman B, Kahn SE, Haffner SM, et al.: Phenotypic characteristics of GAD antibody-positive recently diagnosed patients with type 2 diabetes in North America and Europe. Diabetes 2004, 53:3193–3200.

    Article  PubMed  CAS  Google Scholar 

  21. Hosszufalusi N, Vatay A, Rajczy K, et al.: Similar genetic features and different islet cell autoantibody pattern of latent autoimmune diabetes in adults (LADA) compared with adult-onset type 1 diabetes with rapid progression. Diabetes Care 2003, 26:452–457.

    Article  PubMed  Google Scholar 

  22. Brooks-Worrell BM, Juneja R, Minokadeh A, et al.: Cellular immune responses to human islet protein in antibody positive type 2 diabetic patients. Diabetes 1999, 48:983–988.

    Article  PubMed  CAS  Google Scholar 

  23. Goel A, Chiu H, Felton J, et al.: T-cell responses to islet antigens improves detection of autoimmune diabetes and identifies patients with more severe beta-cell lesions in phenotypic type 2 diabetes. Diabetes 2007, 56:2110–2115.

    Article  PubMed  CAS  Google Scholar 

  24. Shimada A, Imazu Y, Morinaga S, et al.: T-cell insulitis found in anti-GAD65+diabetes with residual beta-cell function. A case report. Diabetes Care 1999, 22:615–617.

    Article  PubMed  CAS  Google Scholar 

  25. Maier LM, Wicker LS: Genetic susceptibility to type 1 diabetes. Curr Opin Immunol 2005, 17:601–608.

    Article  PubMed  Google Scholar 

  26. Sabbah E, Savola K, Ebeling T, et al.: Genetic, autoimmune, and clinical characteristics of childhood-and adult-onset type 1 diabetes. Diabetes Care 2000, 23:1326–1332.

    Article  PubMed  CAS  Google Scholar 

  27. Horton V, Stratton I, Bottazzo GF, et al.: Genetic heterogeneity of autoimmune diabetes: age at presentation in adults is influenced by HLA DRB1 and DQB1 genotypes (UKPDS 43). Diabetologia 1999, 42:608–616.

    Article  PubMed  CAS  Google Scholar 

  28. Desai M, Zeggini E, Horton VA, et al.: An association analysis of the HLA gene region in latent autoimmune diabetes in adults. Diabetologia 2007, 50:68–73.

    Article  PubMed  CAS  Google Scholar 

  29. Desai M, Zeggini E, Horton VA, et al.: The variable number of tandem repeats upstream of the insulin gene is a susceptibility locus for latent autoimmune diabetes in adults. Diabetes 2006, 55:1890–1894.

    Article  PubMed  Google Scholar 

  30. Haller K, Kisand K, Pisarev H, et al.: Insulin gene VNTR, CTLA-4+49A/G and HLA-DQB1 alleles distinguish latent autoimmune diabetes in adults from type 1 diabetes and from type 2 diabetes group. Tissue Antigens 2007, 69:121–127.

    Article  PubMed  CAS  Google Scholar 

  31. Vatay A, Rajczy K, Pozsonyi E, et al.: Differences in the genetic background of latent autoimmune diabetes in adults (LADA) and type 1 diabetes mellitus. Immunol Lett 2002, 4:109–115.

    Article  Google Scholar 

  32. Fourlanos S, Perry C, Stein MS, et al.: A clinical screening tool identifies autoimmune diabetes in adults. Diabetes Care 2006, 29:970–975.

    Article  PubMed  Google Scholar 

  33. Davis TM, Wright AD, Mehta ZM, et al.: Islet autoantibodies in clinically diagnosed type 2 diabetes: prevalence and relationship with metabolic control (UKPDS 70). Diabetologia 2005, 48:695–702.

    Article  PubMed  CAS  Google Scholar 

  34. Carlsson A, Sundkvist G, Groop L, Tuomi T: Insulin and glucagon secretion in patients with slowly progressing autoimmune diabetes (LADA). J Clin Endocrinol Metab 2000, 85:76–80.

    Article  PubMed  CAS  Google Scholar 

  35. Vauhkonen I, Niskanen L, Knip M, et al.: Subtle hyperproinsulinaemia characterises the defective insulin secretory capacity in offspring of glutamic acid decarboxylase antibody-positive patients with latent autoimmune diabetes mellitus in adults. Eur J Endocrinol 2005, 153:265–273.

    Article  PubMed  Google Scholar 

  36. Bottazzo GF, Bosi E, Cull CA, et al.: IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71). Diabetologia 2005; 48:703–708.

    Article  PubMed  CAS  Google Scholar 

  37. Kasuga A, Maruyama T, Nakamoto S, et al.: High-titer autoantibodies against glutamic acid decarboxylase plus autoantibodies against insulin and IA-2 predicts insulin requirement in adult diabetic patients. J Autoimmun 1999, 12:131–135.

    Article  PubMed  CAS  Google Scholar 

  38. Bonifacio E, Bingley PJ, Shattock M, et al.: Quantification of islet-cell antibodies and prediction of insulin-dependent diabetes. Lancet 1990, 335:147–149.

    Article  PubMed  CAS  Google Scholar 

  39. Hampe CS, Hall TR, Agren A, Rolandsson O: Longitudinal changes in epitope recognition of autoantibodies against glutamate decarboxylase 65 (GAD65Ab) in prediabetic adults developing diabetes. Clin Exp Immunol 2007, 148:72–78.

    PubMed  CAS  Google Scholar 

  40. Kobayashi T, Tanaka S, Okubo M, et al.: Unique epitopes of glutamic acid decarboxylase autoantibodies in slowly progressive type 1 diabetes. J Clin Endocrinol Metab 2003, 88:4768–4775.

    Article  PubMed  CAS  Google Scholar 

  41. Vauhkonen I, Niskanen L, Knip M, et al.: Impaired insulin secretion in non-diabetic offspring of probands with latent autoimmune diabetes mellitus in adults. Diabetologia 2000, 43:69–78.

    Article  PubMed  CAS  Google Scholar 

  42. Törn C, Landin-Olsson M, Ostman J, et al.: Glutamic acid decarboxylase antibodies (GADA) is the most important factor for prediction of insulin therapy within 3 years in young adult diabetic patients not classified as type 1 diabetes on clinical grounds. Diabetes Metab Res Rev 2000, 16:442–447.

    Article  PubMed  Google Scholar 

  43. Borg H, Gottsater A, Landin-Olsson M, et al.: High levels of antigen-specific islet antibodies predict future beta-cell failure in patients with onset of diabetes in adult age. J Clin Endocrinol Metab 2001, 86:3032–3038.

    Article  PubMed  CAS  Google Scholar 

  44. Desai M, Cull CA, Horton VA, et al.: GAD autoantibodies and epitope reactivities persist after diagnosis in latent autoimmune diabetes in adults but do not predict disease progression: UKPDS 77. Diabetologia 2007, 50:2052–2060.

    Article  PubMed  CAS  Google Scholar 

  45. Hampe CS, Nalini R, Maldonado MR, et al.: Association of amino-terminal-specific antiglutamate decarboxylase (GAD65) autoantibodies with beta-cell functional reserve and a milder clinical phenotype in patients with GAD65 antibodies and ketosis-prone diabetes mellitus. J Clin Endocrinol Metab 2007, 92:462–467.

    Article  PubMed  Google Scholar 

  46. Steffes MW, Sibley S, Jackson M, Thomas W: Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial. Diabetes Care 2003, 26:832–836.

    Article  PubMed  Google Scholar 

  47. Maruyama T, Shimada A, Kanatsuka A, et al.: Multicenter prevention trial of slowly progressive type 1 diabetes with small dose of insulin (the Kyoto study): preliminary report. Ann N Y Acad Sci 2003, 1005:362–369.

    Article  PubMed  CAS  Google Scholar 

  48. Cabrera-Rode E, Perich P, Diaz-Horta O, et al.: Slowly progressing type 1 diabetes: persistence of islet cell autoantibodies is related to glibenclamide treatment. Autoimmunity 2002, 35:469–474.

    Article  PubMed  Google Scholar 

  49. Zhou Z, Li X, Huang G, et al.: Rosiglitazone combined with insulin preserves islet beta cell function in adult-onset latent autoimmune diabetes (LADA). Diabetes Metab Res Rev 2005, 21:203–208.

    Article  PubMed  Google Scholar 

  50. Pozzilli P, Guglielmi C: Immunomodulation for the prevention of SPIDDM and LADA. Ann N Y Acad Sci 2006, 1079:90–98.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jochen Seissler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seissler, J. Latent (slowly progressing) autoimmune diabetes in adults. Curr Diab Rep 8, 94–100 (2008). https://doi.org/10.1007/s11892-008-0018-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-008-0018-x

Keywords

Navigation