Latent Autoimmune Diabetes in Adults

Context: Autoantibodies that are reactive to islet antigens are present at the time of diagnosis in most patientswith type 1diabetes. Additionally, approximately 10%of phenotypic type 2diabetic 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 under-standing of LADAbased on theMEDLINE search of all peer-reviewed publications (original articles and reviews) on this topic between 1974 and 2009. Conclusions: InLADA,diabetesoccursearlier inthe-cell-destructiveprocessbecauseofthegreater insulin resistance.Complexities arisealsobecauseofvariabledefinitionsof LADAandtype1diabetes inadults.As immunomodulatory therapies that sloworhalt the type1diabetes diseaseprocess arediscovered, testing these therapies in LADAwill be essential. (J Clin Endocrinol Metab 94: 4635–4644, 2009