Context: the aim of this review is to explore the pathogenic and clinical spectrum of type 1 diabetes which includes a form of adult onset autoimmune diabetes usually referred to as latent autoimmune diabetes in adults (LADA). We look at this entire range of forms of autoimmune diabetes as a spectrum of genetic and non-genetic environmental influences, of diabetes-associated immune responses and of metabolic changes.

Evidence Acquisition: we assessed epidemiological, genetic, immunological and clinical data from major articles on autoimmune diabetes, including LADA and type 1 diabetes, published since 1992.

Evidence Synthesis: data analysis of autoimmune diabetes indicate that type 1 diabetes and LADA occupy different poles of the same spectrum.

Conclusion: evidence is presented that LADA represents one end of a ‘rainbow’ encompassing type 1 diabetes. The clinical nature and management of autoimmune diabetes poses important therapeutic questions regarding conventional therapy for hyperglycaemia as well as therapy aiming to protect residual cell function. Limiting loss of endogenous insulin secretion using immunomodulation could be valuable, not only for LADA, but also for type 1 diabetes.