Get rid of the "like type 1 also like type 2" confusion "type 1.5" diabetes diagnosis and treatment of the international consensus published

Type 1 diabetes and type 2 diabetes are the main categories of diabetes, but not all patients are fully compliant with the existing classification.
30 years ago, the medical community observed that a significant number of patients had certain characteristics of type 1 and type 2 diabetes: they had immune markers for type 1 diabetes in their bodies, some like slow-moving autoimmune diabetes, but were diagnosed without insulin treatment, similar to 2 diabetes patients.
these patients are known as adult latent autoimmune diabetes (LADA), also known as type 1.5 diabetes.
, these patients account for about 2% to 12% of all diabetics, and there are about 6 million people in China.
, although this diabetic subsype is widely recognized, there has been a lack of uniform standards of diagnosis and treatment, for LADA's autoantibodies screening methods, diagnostic standards and other differences.
recently, an international panel of experts reached a consensus on the diagnosis and treatment of LADA after in-depth discussions, and was officially published in Diabetes, the official journal of the American Diabetes Association (ADA).
this consensus mainly clarifies (1) the diagnostic criteria for LADA patients, (2) the review of evidence of current treatment options, and (3) the recommendations for LADA diagnosis and treatment.
Screenshot Source: Diabetes Adult Latent Autoimmune Diabetes (LADA) Definition In consensus, the panel defined the general characteristics of LADA as follows: . . . age of onset ; There was no disease-specific difference in cardiovascular outcomes between PATIENTs with LADA and patients with type 2 diabetes; The rate of decline in C peptide levels is slower than in people with type 1 diabetes; Glutamate deaminase autoantibodies (GADA) positive is the most sensitive marker, there are other autoantibodies (such as ICA, IA-2A, ZnT8A and tetraspanin 7), but the frequency is low; Insulin treatment is not required at the time of onset.
, delayed on-the-go (at the time of diagnosis), presence of diabetes-related autoantibodies and no insulin requirements for at least 6 months after diagnosis are currently the most important diagnostic criteria for LADA.
these screening conditions are not absolute.
also notable that similar patients, known as latent autoimmune diabetes (LADY), have been observed in younger cases.
Expert Group recommends LADA treatment strategies: according to C peptide levels, the current overall treatment strategy is designed to control metabolic health and retain residual insulin secretion capacity, but differences between LADA patients suggest the need to consider relatively individual treatment strategies.
expert group suggested that patients were divided into three categories based on C peptide levels (reference indicators for insulin secretion) that represented β cellular function, and different treatment strategies were adopted.
(1) C peptide levels - lt;0.3 nmol/L: Recommended for a variety of insulin treatment options for people with type 1 diabetes.
(2) 0.3 nmol/L≤C peptide ≤ 0.7nmol/L.
expert group classified it as a "grey area" with the option of starting treatment with metformin, while keeping a close eye on whether patients needed insulin therapy.
should be followed up and reassessed at least every 6 months.
some patients may need to consider combining insulin and other therapies as early as possible to β cell failure and reduce diabetes complications.
recommends using an ADA/EASD improvement strategy for type 2 diabetes to select medications based on patients' glycation of hemoglobin levels, combined atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), cardiovascular disease (CVD), heart failure (HF) and other combined diseases (figure below).
treatment strategies for LADA patients with 0.3 nmol/L≤C peptide levels ≤0.7nmol/L (Photo source: References.
blood sugar control deteriorates, C peptide levels should be re-measured.
Group of Experts reviews and evaluates existing sugar-lowering treatment options for insulin-sensitive agents (metformin, pyroidoxone): Currently, most LADA patients are clinically diagnosed with type 2 diabetes and use metformin as the preferred treatment.
Expert Group found that there was limited evidence to support the use of metformin, but there was no evidence against the use of metformin;
for the latter, there is a potential risk of atypical fractures, macular edema and weight gain.
: Insulin therapy must be initiated in all cases where C peptides cannot be detected, and insulin intervention is effective and safe for LADA patients.
But patients who are initially diagnosed with LADA usually have residual β cellular function, which has since slowly developed into insulin dependence, and whether insulin should be treated as an initial treatment for LADA remains to be determined, with no data available from large randomized controlled trials.
sulfonylurea drugs: Sulfonylurea drugs are not recommended for THEA treatment, as the risk of these drugs leading to β cell function cannot be ruled out.
DPP-4 inhibitors: can improve blood sugar control in LADA patients, and has good safety.
needs to conduct a wider randomized study to prove that DEP-4 inhibitors retain insulin secretion.
SGLT2 inhibitors: Based on the approved use of these drugs in type 2 diabetes and some type 1 diabetic patients, especially overweight patients, SGLT2 inhibitors may have the potential to treat LADA, but no studies have been conducted.
addition, LADA patients with lower levels of C peptides (i.e., more "like" type 1 diabetes) need to be used with caution, which may increase the risk of diabetic ketoacidosis.
GLP1-like agonists: beneficial results have been shown in improving metabolic control in PATIENT patients, unless the patient's C peptide levels are very low.
drugs have been approved for type 2 diabetes and insulin treatment in patients, but more evidence is needed for LADA patients.
: data are limited and more extensive research is needed before conclusions can be drawn.
: Lifestyle changes are important for the treatment of type 2 diabetes.
interventional studies are needed to assess the role of weight loss and physical activity in controlling the progression of LADA.
the consensus on how future research will close the knowledge gap, the panel said the LADA recommendation was more of a "try" but there were still many challenges in the diagnosis and treatment of LADA. the
expert group called for future research to focus on: LADA routine screening for first-time non-insulin-demand diabetic patients to explore personalized treatments, more randomized controlled trials to explore the most suitable anti-sugar drugs for LADA patients, large-scale long-term studies in different patient populations, patients of different ethnicities, study the quality of life and lifestyle impact of LADA patients, study the characteristics of autoantibodies in LADA patients, University of Southern California diabetes expert Anne L. Professor Peters commented that the consensus may raise more questions that are not currently answered, but this at least allows us to "get rid of the confusion about the definition of LADA" and provide a preliminary guidance framework for the treatment of LADA patients.
references to Raffaella Buzzetti, et al., (2020). Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes, DOI: What Is LADA and How Should We Treat It?. Retrieved October 26, 2020, from