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Insulin and Glucagon Secretion in Patients with Slowly Progressing Autoimmune Diabetes (LADA)¹

Department of Endocrinology, University of Lund, S-205 02 Malmo, Sweden (Å.L.C., G.S., L.G., T.T.) and the Department of Internal Medicine, Helsinki University Central Hospital (T.T.), Helsinki, Finland

Address all correspondence and requests for reprints to: Tiinamaija Tuomi, M.D., Wallenberg Laboratory, Department of Endocrinology, University of Lund, S-205 02 Malmo, Sweden.

To metabolically characterize patients with slowly progressing autoimmune diabetes (LADA) of short duration we measured insulin, C peptide, and glucagon responses to glucose and arginine at three blood glucose levels (fasting and 14 and 28 mmol/L) in 11 patients with LADA, 11 patients with type 2 diabetes, and 14 healthy control subjects matched for age and body mass index. The acute insulin response to arginine was impaired in LADA vs. type 2 diabetes at all glucose levels, with the greatest impairment in the maximally stimulated insulin concentrations (P < 0.04). In contrast, ß-cell sensitivity to glucose was unaltered in LADA and type 2 diabetes. The glucagon concentrations were elevated in both LADA and type 2 diabetic patients compared with healthy control subjects (P < 0.02), but did not differ between the diabetic groups. In conclusion, patients with LADA share insulin resistance with type 2 diabetic patients, but display a more severe defect in maximally stimulated ß-cell capacity than patients with type 2 diabetes.

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