The surest way to determine if a person has latent autoimmune diabetes of adulthood (LADA) is through a blood test for abnormal pancreatic antibodies. Though not yet part of standard clinical practice, this autoantibody testing may be performed if a physician suspects LADA.

Such testing reveals the presence of islet cell antibodies (ICA), insulin autoantibodies (IAA), tyrosine phosphatase antibodies and/or glutamic acid decarboxylase (a beta cell protein known as GAD). In people with LADA and other forms of type 1 diabetes, the body’s immune system mistakenly attacks the insulin-making beta cells of the pancreas. The most common of these autoantibodies is the GAD protein, but any of them can help confirm a LADA diagnosis.

Additionally, the level of c-peptide, a protein fragment generated during insulin production, may be checked in a c-peptide test. This blood test can help the physician differentiate LADA from type 2 diabetes and suggest the extent of damage to the beta cells.

For nearly half of patients with LADA, insulin administration is required within four years of diagnosis, a sharp contrast to the average of more than 10 years for patients with type 2 diabetes who become insulin dependent. In fact, it is possible for patients to go for months or even up to six years with type 2 treatments before it becomes obvious that they have LADA – and they might be diagnosed only when they become dependent on insulin.

Thus, if LADA has been determined, most physicians recommend that insulin treatment begin immediately upon diagnosis as it may retard the autoimmune destruction of beta cells. Studies are under way to investigate ways to preserve insulin function in patients with LADA.

Syringe injections are the most common way of delivering insulin. Other options may include inhaled insulin, insulin pens, jet injectors or an insulin pump. Some patients with LADA may qualify for a pancreas transplant or an islet cell transplant.

The physician will establish a target glucose range and schedule of glucose monitoring. The treatment plan typically includes diet and exercise to maintain health and prevent double diabetes. Regular medical care includes physical examinations and establishment of a sick-day plan. A pneumonia vaccination and annual flu shots are generally recommended. Patients, especially those at high risk for hypoglycemia, may be advised to carry a glucagon kit.

The physician will recommend a schedule of:

• Glycohemoglobin testing to assess long-term diabetic management
  
  
• Complete foot examinations to reduce the risk of foot problems
  
  
• Dilated pupil examinations to detect diabetic retinopathy, glaucoma, cataracts and other eye diseases
  
  
• Cholesterol tests and blood pressure monitoring to help prevent heart conditions and stroke
  
  
• Microalbuminuria tests to monitor kidney function and prevent diabetic nephropathy
  
  
• Neurological examinations to diagnose and control diabetic neuropathy

For LADA patients with unstable diabetes, an option to improve glycemic control may be a recently approved injectable antidiabetic agent called pramlintide.

Researchers are investigating whether thiazolidinediones and some other oral diabetes drugs may slow the autoimmune destruction of the pancreas and help preserve the insulin-producing beta cells. This area is being explored cautiously because some research has suggested that sulfonylureas may hasten pancreatic damage in people with LADA.

Although testing for LADA is not yet routine in the diagnosis of diabetes, it is expected that early identification of the condition may one day be standard. However, routine screening most likely will take place only after an effective immune intervention is developed – one that can stop the destruction of beta cells and meet the unique insulin requirements of these patients.