Screening of latent autoimmune diabetes in insulin requiring diabetic adults
R Ben Said, I Kammoun, I Oueslati, Y Htira, C Bouzid, L Ben Salem & C Ben Slama
Introduction: Latent autoimmune diabetes in adults (LADA) is a genetically linked, autoimmune form of type 1 diabetes mellitus (DM) that accounts for 212% of all cases of diabetes.
The goal of our study is to detect LADA among patients who were diagnosed as type 2 DM and who became insulin requiring.
Methods: Our study included 45 patients (15 men, 30 women) diagnosed as type 2 DM, who had a poor glycemic control on oral hypoglycemic drugs, and so became on insulin therapy.
These patients had systematically islet auto antibodies testing (anti glutamic acid decarboxylase 65 (antiGAD 65), anti islet cell cytoplasm (ICA) and anti tyrosine phosphatase like protein (IA2A)).
Results: All our patients were aged more than 30 (mean age: 49±11.3). They have been on oral hypoglycaemic drugs for at least one year (mean duration: 4±2,7 years). They presented with poor glycemic control (mean HbA1c: 11.9±2.36%) and they had an important weight loss (13 kg ±9.4).
AntiGAD 65 were detected in 32.4% of our patients, ICA in 13% and IA2A in 4,3%. 44% of patients with positive test presented with ketosis.
Conclusion: Approximately, 10 to 30% of adults diagnosed with type 2 DM are positive for islet auto antibodies, which means that they had in fact a LADA.
Single antibody positivity for GAD is more frequent than ICA and IA2A, like in our study.
Our results are particularly interesting because they show a relatively high prevalence of LADA in our population. It is important to recognize these patients to prevent complications like ketosis.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.