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Latent Autoimmune Diabetes in Adults

Charles River Clinical Services Northwest (R.G.N.), Tacoma, Washington 98418; and Department of Medicine (B.M.B.-W., J.P.P.), Division of Endocrinology, Metabolism, and Nutrition, Department of Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington 98108

Address all correspondence and requests for reprints to: Jerry P. Palmer, M.D., Director of Endocrinology, Department of Veterans Affairs Puget Sound Health Care System, Professor of Medicine, University of Washington, 1660 South Columbian Way (111), Seattle Washington 98108. E-mail: jpp{at}u.washington.edu.

Context: Autoantibodies that are reactive to islet antigens are present at the time of diagnosis in most patients with type 1 diabetes. Additionally, approximately 10% of phenotypic type 2 diabetic patients are positive for at least one of the islet autoantibodies, and this group is often referred to as "latent autoimmune diabetes in adults (LADA)." These patients share many genetic and immunological similarities with type 1 diabetes, suggesting that LADA, like type 1 diabetes, is an autoimmune disease. However, there are differences in autoantibody clustering, T cell reactivity, and genetic susceptibility and protection between type 1 diabetes and LADA, implying important differences in the underlying disease processes.

Evidence Acquisition and Synthesis: In this clinical review, we will summarize the current understanding of LADA based on the MEDLINE search of all peer-reviewed publications (original articles and reviews) on this topic between 1974 and 2009.

Conclusions: In LADA, diabetes occurs earlier in the β-cell-destructive process because of the greater insulin resistance. Complexities arise also because of variable definitions of LADA and type 1 diabetes in adults. As immunomodulatory therapies that slow or halt the type 1 diabetes disease process are discovered, testing these therapies in LADA will be essential.

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