Endocrine Abstracts

JOINT3510

Introduction: The diagnosis of diabetes between the ages of 25 and 45 can be complicated, as the less common subtypes of diabetes sometimes overlap with characteristics typical of type 1 and type 2 diabetes mellitus (DM). Latent Autoimmune Diabetes in Adults (LADA) shares an autoimmune component with DM1, and therefore, there is an early progression towards insulinopenia compared to DM2. However, in most cases, patients initially present good control using only non-insulin antidiabetic drugs, similar to DM2. For this reason, patients are often initially misdiagnosed with DM2. In patients with clinically compatible characteristics, it is essential to determine autoantibodies against pancreatic beta-cell structures to establish the correct diagnosis. The literature indicates that the most frequently present and sensitive antibodies are anti-glutamic acid decarboxylase antibodies (anti-GAD). However, other autoantibodies may also be present.

Material and Methods: A descriptive and cross-sectional study was conducted to assess the clinical and demographic characteristics of patients with LADA. A sample of 44 patients aged between 38 and 72 years (mean age of 50.9 years), 56.8% of whom were women, was evaluated between 2022 and 2023 in the Endocrinology Department of “Hospital Universitario de Canarias”, Spain.

Results: A retrospective assessment was made regarding the following: diagnosis change, diagnostic delay, presence of autoantibodies (anti-GAD and anti-IA2), initial glycated hemoglobin, final glycated hemoglobin, C-peptide levels, time treated only with non-insulin antidiabetic drugs, time treated only with basal insulin, time to the initiation of basal-bolus regimen, and the use of continuous glucose monitoring (CGM) systems.

• Mean time of diagnostic delay (years): 6.5

• Mean initial HbA1c: 8.7%

• Mean final HbA1c: 7.4%

• Mean treatment time with non-insulin antidiabetic drugs (years): 2.65

• Mean time treated with only basal insulin (months): 9

• Mean time until the initiation of basal-bolus regimen (years): 3.7

• Diagnosis change:81.8% of patients

• Use of CGM:88.6% of patients

• Autoantibodies:Only anti-GAD positive: 48.7%; Only anti-IA2 positive: 15.38%; Both positive: 35.89%

• C-peptide levels (ng/mL):<0.5: 38.7%; 0.5-2: 54.83%; >2: 10.52%

Conclusion: Although LADA is a recognized form of diabetes, no specific guidelines have been established for its management, and it is often confirmed years after an initial diagnosis of DM. An individualized approach should be taken, considering the metabolic characteristics as well as the signs and symptoms of insulinopenia (emphasizing the importance of determining C-peptide levels in diagnosis and follow-up).