Treatment Options for LADA

Latent autoimmune diabetes in adults (LADA), also called “slow-onset type 1 diabetes,” is often misdiagnosed from the start. 

Since LADA develops later in life than typical type 1 diabetes (generally after the age of 30), front-line healthcare professionals often mistake it for type 2 diabetes. In fact, in LADA, as in type 1 diabetes, antibodies destroy the pancreas’ insulin-producing beta cells. The destruction occurs much quicker in LADA than it does in type 2 diabetes, but also slower than in typical type 1 diabetes. For this reason, patients often don’t need to take any insulin in the first six months after being diagnosed with LADA. But ultimately, the same treatment as the one required for typical type 1 diabetes will be required.

Ideally, treatment for LADA should aim to protect the beta cells and to delay their full destruction in order to maintain the natural secretion of insulin for as long as possible. 

But it’s still unclear whether using oral medication—usually for type 2 diabetes—or starting on insulin as early as possible is better.

A recent 21-month Scandinavian study involving 64 people with LADA, aged 30 to 75, observed and compared the impact of two treatments: early start on insulin, and Sitagliptin (Januvia®), an oral medication generally used by type 2 diabetes patients. Sitagliptin makes the pancreas secrete insulin when blood sugar levels are high. Some doctors are worried that this simpler treatment, when used by people with LADA, might wear out the pancreas faster. 

Participants were divided in two groups: one group received an insulin treatment and the other received Sitagliptin. 

Same level of beta cell preservation

At the end of the study, the participants’ fasting blood sugar levels, hemoglobin A1c and natural secretion of insulin by the pancreas were similar, regardless of what treatment they received— insulin or Sitagliptin. 

The only difference that was observed had to do with weight. The insulin-treated group gained weight (+1.9 kg) while the Sitagliptin-treated group lost weight (-3.4 kg).

High levels of anti-GAD antibodies: an indicator of the severity of beta cell deterioration

In both groups, the decline in natural secretion of insulin by the pancreas was greater for participants who had high levels of anti-GAD antibodies at the start of the study.   

This study demonstrates that taking Sitagliptin or a similar medication won’t accelerate the deterioration of pancreas beta cells for people with LADA. But it’s important to get the right diagnosis for this type of diabetes from the start in order to get the best treatment. 

It’s also important to stay vigilant when anti-GAD antibody levels are high, since the natural secretion of insulin may be declining more quickly and insulin injections may be required earlier.

About 7% of BETTER registry participants live with LADA. Help us paint an accurate picture of type 1 diabetes in Quebec.  

If you or your child are living with type 1 diabetes in Quebec, sign up for the registry here:

www.type1better.com

Reference:

  • Hals, I.K., et al. (2019). Investigating optimal β-cell-preserving treatment in latent autoimmune diabetes in adults: Results from a 21-month randomized trial. Diabetes, Obesity and Metabolism, 21(10):2219–2227. doi: 10.1111/dom.13797