Autoimmune diabetes in adults: lessons from the UKPDS

Diabetic Medicine : a Journal of the British Diabetic Association
M Desai, A Clark

Abstract

Latent autoimmune diabetes in adults (LADA) is characterised by a relatively mild diabetes onset, autoantibody positivity and eventual requirement for insulin therapy. Twelve per cent of newly diagnosed, UK Prospective Diabetes Study (UKPDS) patients were positive for autoantibodies to GAD65 (GADA) and/or insulinoma-associated antigen-2A (IA-2A) and managed as if they had Type 2 diabetes according to the UKPDS protocol. Here, we compare data from UKPDS LADA patients with that from other cohorts. In common with other groups, UKPDS LADA patients required insulin therapy earlier post-diagnosis than non-LADA patients. Reduction of islet function was similar in UKPDS LADA groups randomised to oral glucose-lowering agents or insulin replacement therapy, contesting the current hypothesis of reduced decline of insulin secretion in LADA by immediate insulin therapy. Disease progression was not predicted by post-diagnosis GADA levels or epitope specificities as has been suggested. Slowly progressing insulitis and pancreatic beta-cell loss at post-mortem are consistent with sustained retention of residual C-peptide secretion in LADA. Genetic association patterns at the human leucocyte antigen (HLA) and insulin gene (INS) regions are simil...Continue Reading

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Citations

Feb 17, 2009·Diabetes/metabolism Research and Reviews
Jun 4, 2010·Diabetes Care·Georgeanna J KlingensmithUNKNOWN TODAY Study Group
Sep 22, 2010·Diabetes Care·Barbara M Brooks-WorrellJerry P Palmer
Sep 9, 2011·The Cochrane Database of Systematic Reviews·Sinead BrophyRhys Williams
Mar 3, 2010·The Journal of Clinical Endocrinology and Metabolism·Robert J SmithJerome I Rotter
Apr 25, 2016·Annals of Global Health·Ivica SmokovskiAleksandar Mitov

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