Latent autoimmune diabetes in adults (LADA) : a guide for GPs

Latent autoimmune diabetes in adults (LADA) is a slowly progressive form of autoimmune diabetes that shares features of both type 1 and type 2 diabetes—hence often referred to as “type 1.5 diabetes.”

Key Features:

• Autoimmune basis: Presence of islet cell autoantibodies (e.g. GAD65), as in type 1 diabetes.

• Adult onset: Typically diagnosed between 35–70 years.

• Gradual progression: Slower β-cell decline than type 1; insulin not required immediately.

Epidemiology:

• Affects ~10% of adults with diabetes (Pozzilli & Pieralice, 2018), though prevalence ranges from 2–12%.

• Up to 14% of people initially diagnosed with type 2 diabetes (T2DM) may actually have LADA (Qi et al., 2010).

LADA is driven by a chronic autoimmune attack on pancreatic β-cells, leading to progressive insulin deficiency. However, unlike classic type 1 diabetes, the autoimmune process is less aggressive, allowing for a slower decline in β-cell function.

Key Mechanisms:

• Autoimmune destruction of β-cells → ↓ insulin secretion over time.

• Initial insulin independence: Endogenous insulin production persists post-diagnosis (Carlsson, 2019).

• Delayed insulin need: Most patients require insulin within 3–6 years.

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Genetic Susceptibility:

• Shares risk alleles with both:

  • Type 1 diabetes: e.g. HLA-DQB1...