Pozzilli and Di Mario describe a number of features of latent autoimmune diabetes of the adult (LADA). The authors are from Universita Campus Biomedico and Universita La Sapienza in Rome.


Clinical features:

(1) onset of diabetes in an adult

(2) insulin not required at the time of diagnosis

(3) several markers of autoimmune diabetes including any combination of:

(3a) HLA-DR3 or HLA-DR4

(3b) antibodies to islet cells

(3c) antibodies to glutamic acid decarboxylase (GAD)

(4) variable progression to insulin dependence

(5) other endocrine autoantibodies (anti-thyroid, anti-adrenal, etc)

(6) family history of Type I diabetes or autoimmune endocrinopathy


The patient typically has a low body mass index (BMI).


A patient with antibodies to islet cells or GAD are more likely to develop insulin dependence.


A patient with latent autoimmune diabetes may show a defect in maximally stimulated beta-cell capacity. These patients produce enough insulin for usual requirements but do not have much reserve capacity. One test is to measure C-peptide response following administration of glucagon.


Differential diagnosis:

(1) pancreatic destruction in a patient with non-insulin dependent diabetes


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