Diabetes mellitus can affect anyone, regardless of age. We’re not just talking about a specific type of diabetes that occurs in childhood or adulthood. A special form of diabetes can also occur in late adulthood, known as LADA diabetes.
The standard diagnostic is not sufficient
People with type 1 diabetes know that they suffer from an autoimmune disease. This means that they produce antibodies that destroy their β cells. The same thing happens in LADA diabetes, but much more slowly. That’s why it’s called “LADA”, which stands for “Latent Autoimmune Diabetes in Adults“.
However, the standard laboratory parameters for diagnosis are not always meaningful. Blood sugar as a single parameter hardly tells us anything. It’s different when HbA1c (“long-term blood sugar”) and insulin levels are also measured. However, these parameters cannot distinguish between different types of diabetes.
A common parameter for determining endogenous insulin production is the so-called C-peptide. The C-peptide is a by-product of insulin production. However, this value also only tells us something to a limited extent. If C-peptide is measured, it simply means that insulin is still being produced. However, it says nothing about the state of the immune system.
The question is, why not just measure the concentration of suspicious antibodies?
Measuring antibodies is advisable – misdiagnosis is an additional burden
In fact, this is exactly possible. Antibodies against cytoplasmic islet cells (ICA), insulin (IAA), glutamic acid decarboxylase (GAD65), and tyrosine kinase IA-2 (IA-2A) are the most important in type 1 diabetes. In particular, the measurement of GAD65 and IA-2A could enable a differentiated diagnosis between different types of diabetes.
The tricky thing is that until now, many people with LADA diabetes have been misdiagnosed. This means that they are treated with oral therapy with so-called antidiabetic drugs. Unfortunately, this form of therapy often places an additional burden on the insulin-producing β cells.
To be able to optimally treat people with LADA diabetes, it is recommended to include measurements of antibodies. Immediate insulin therapy can result in the person benefiting from the remission phase earlier and for a much longer period of time, as the β cells are relieved by the administered insulin.
An early and well-timed insulin therapy can lead to a long remission phase with stable blood sugar control. This results in a higher quality of life and fewer late complications from diabetes itself.
Sources
- Antibodies to IA-2 and GAD65 in type 1 and type 2 diabetes: isotype restriction and polyclonality. M I Hawa, D Fava, F Medici, Y J Deng, A L Notkins, G De Mattia, R D Leslie Diabetes Care Feb 2000, 23 (2) 228-233; DOI: 10.2337/diacare.23.2.228
- Recombinant Titel anhand dieser DOI in Citavi-Projekt übernehmen Fabs of Human Monoclonal Antibodies Specific to the Middle Epitope of GAD65 Inhibit Type 1 Diabetes–Specific GAD65Abs Carolyn J. Padoa, J. Paul Banga, Anne-Marie Madec, Manfred Ziegler, Michael Schlosser, Eva Ortqvist, Ingrid Kockum, Jerry Palmer, Olov Rolandsson, Katherine A. Binder, Jefferson Foote, Dong Luo, Christiane S. Hampe Diabetes Nov 2003, 52 (11) 2689-2695; DOI: 10.2337/diabetes.52.11.2689
