Endocrine Abstracts

Background: Latent autoimmune diabetes (LAD) is a slow progressive autoimmune destruction of pancreatic beta cells leading to reduced insulin production. When it occurs in a young people, it is called as latent autoimmune diabetes of young (LADY)^[1].

Case Presentation: We present a case of a 36 years old male who presented at the age of 26 years with new diagnosis of diabetes. He was initially treated as type 2 diabetes given minimal osmotic symptoms, high basal mass index (BMI) of 31 kg/m2 and good response to metformin and gliclazide bringing the HbA1c from 90 to 48 mmol/mol in 3 months. His C-peptide was detected however Anti GAD (Glutamic Acid Decarboxylase) antibodies was slightly raised with negative rest of the diabetes autoantibodies. He remained insulin independent for approximately 3 years when his diabetes control started to deteriorate with HbA1c rising to 79 mmol/mol. He was then started on basal insulin glargine and continued with metformin to improve insulin resistance given high BMI. This resulted in improvement in HbA1c. His C-peptide was again checked which showed only slight reduction as compared to the diagnosis C-peptide however it was still detectable. His insulin requirement remained low at 0.2 Units/kg. 10 years post diabetes diagnosis, his diabetes remained excellent on low dose of insulin glargine and metformin 2g/day and C-peptide still remained detectable confirming the diagnosis of LADY.

Conclusion: This case highlights the need for better knowledge to prevent misdiagnosis of LAD as type 2 diabetes, the importance of regular follow-up, and a low threshold for starting insulin therapy to prevent diabetic ketoacidosis and long-term complications^[1].

Reference: 1. Pampapathi KK, Mon HY, Ibrahim JM, Oyibo SO, Pampapathi Jr K, Ibrahim J. Latent Autoimmune Diabetes in a Young Female: A Case Report. Cureus. 2024 Sep 25;16(9).