Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel
Article Figures & Tables
Figures
- Figure 1
Algorithm for LADA diagnostic pathway based on autoantibody screening and C-peptide levels at diagnosis (to be used when financial restriction does not apply). **Consider also pancreatitis or monogenic diabetes.
- Figure 2
Algorithm for glucose-lowering medications in LADA patients with C-peptide <0.3 mmol/L or with C-peptide ≥0.3 and ≤0.7 nmol/L. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HF, heart failure.
- Figure 3
Algorithm for glucose-lowering medications in LADA patients with C-peptide levels ≥0.3 and ≤0.7 nmol/L without established ASCVD (atherosclerotic cardiovascular disease) or CKD (chronic kidney disease). *Deviation from ADA/EASD T2D algorithm. **Increased risk of diabetic ketoacidosis, especially in patients with BMI ≤27.
Tables
- Table 1
Broad characteristics of LADA*
• Age >30 years** • Family/personal history of autoimmunity • Reduced frequency of metabolic syndrome compared with T2D—lower HOMA, lower BMI, lower blood pressure, and normal HDL compared with T2D • No disease-specific difference in cardiovascular outcomes between these patients and those with T2D • C-peptide levels decrease more slowly than in T1D • Positivity for GADA as the most sensitive marker; other autoantibodies less frequent (ICA, IA-2A, ZnT8A, and tetraspanin 7 autoantibodies) • Non–insulin requiring at onset of diabetes * None of these features categorically define LADA.
** Limited data on older patients with higher probability of T1D in younger patients.
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