Latent autoimmune diabetes in adults: current data (review of literature and own data)

Abstract

The article provides up-to-date information on latent autoimmune diabetes in adults (LADA), presents data on epidemiology, factors and mechanisms of development, clinical features of this disease. The phenotypic variants of the course of LADA are described, the issues of diagnostic features and differential diagnosis are revealed. LADA is a form of diabetes characterized by a less intense autoimmune process and a wide range of clinical signs compared to classical type 1 diabetes mellitus (T1DM) and can have features of both major types of diabetes. Based on the results of epidemiological studies, the prevalence of LADA is approximately 12 % of all cases of diabetes, it is the second most common form of diabetes after type 2 diabetes mellitus (T2DM) and is the most common type of autoimmune diabetes in adults. According to the modern classification, LADA belongs to the autoimmune subtype of T1DM. Since patients do not need insulin at the beginning of the disease, the course of LADA is similar to T2DM, which is the cause of diagnostic errors. The literature data and the results of the conducted research have shown that, in addition to autoimmune damage to pancreatic beta cells, insulin resistance plays a key role in the mechanisms of LADA development, with an increase in the frequency and degree of abdominal obesity, which not only worsens metabolic control and increases the risk of metabolic syndrome, but also causes a decrease in insulin secretion and progression of the autoimmune process. In patients with LADA, the prevalence and degree of obesity, hypertension and dyslipidemia occupy an intermediate position between the classical types of diabetes. Despite having fewer metabolic risk factors compared to T2DM, patients with LADA have the same or even higher risk of death and cardiovascular diseases. The most important diagnostic markers of LADA are levels of C-peptide and autoantibodies against islet antigens. The possibility of a clear diagnosis of LADA is limited due to the significant heterogeneity of the disease due to an overlap of T1DM and T2DM symptoms. According to modern guidelines, therapeutic approaches to LADA, which are based on insulin therapy and metformin, depend on the level of C-peptide. More research is needed to improve personalized approaches to the treatment of this disease.