Clinical characteristics and disease progression of typical adult-onset type 1 diabetes and insulin-dependent latent autoimmune diabetes in adults.
We investigated the characteristics of typical adult-onset type 1 diabetes (T1D) and insulin-dependent latent autoimmune diabetes in adults (LADA) in Thailand.
This retrospective chart review enrolled typical T1D and insulin-dependent LADA patients diagnosed at age ≥30 years, and who were followed up at Siriraj Hospital, Thailand, during 2014-August 2024. Potential patients were searched from the Type 1 Diabetes Registry of Siriraj Diabetes Center and electronic medical record.
Among 84 patients, 32 were typical T1D and 52 LADA. At diagnosis, both groups had normal body mass index (20.9 ± 4.5 kg/m2), significant weight loss (13.3 ± 6.4%), short duration of hyperglycemic symptoms (1 [1-2] months), and high fasting blood glucose (259 [174-345] mg/dL). Diabetic ketoacidosis (DKA) was the first presentation in 76.7% of typical T1D and in 2.6% of LADA. Anti-glutamic acid decarboxylase (anti-GAD) was tested in 91.7% of patients (positive: T1D 72%, LADA 100%). Almost 70% of patients with LADA were initially misdiagnosed as T2D and were ultimately diagnosed at 7.6 [2.6-17.5] years later. Patients with LADA had a higher incidence of recurrent DKA. At latest follow-up, patients with LADA had significantly higher systolic blood pressure (SBP), glycated hemoglobin (HbA1c), and insulin resistance compared to typical T1D.
We found a higher proportion of LADA than typical T1D, and 70% of LADA were initially misdiagnosed as T2D. Both groups were characterized by a normal BMI, significant weight loss, and a short duration of hyperglycemic symptoms. However, LADA rarely presented with DKA and had higher HbA1c and insulin resistance during follow-up.
This retrospective chart review enrolled typical T1D and insulin-dependent LADA patients diagnosed at age ≥30 years, and who were followed up at Siriraj Hospital, Thailand, during 2014-August 2024. Potential patients were searched from the Type 1 Diabetes Registry of Siriraj Diabetes Center and electronic medical record.
Among 84 patients, 32 were typical T1D and 52 LADA. At diagnosis, both groups had normal body mass index (20.9 ± 4.5 kg/m2), significant weight loss (13.3 ± 6.4%), short duration of hyperglycemic symptoms (1 [1-2] months), and high fasting blood glucose (259 [174-345] mg/dL). Diabetic ketoacidosis (DKA) was the first presentation in 76.7% of typical T1D and in 2.6% of LADA. Anti-glutamic acid decarboxylase (anti-GAD) was tested in 91.7% of patients (positive: T1D 72%, LADA 100%). Almost 70% of patients with LADA were initially misdiagnosed as T2D and were ultimately diagnosed at 7.6 [2.6-17.5] years later. Patients with LADA had a higher incidence of recurrent DKA. At latest follow-up, patients with LADA had significantly higher systolic blood pressure (SBP), glycated hemoglobin (HbA1c), and insulin resistance compared to typical T1D.
We found a higher proportion of LADA than typical T1D, and 70% of LADA were initially misdiagnosed as T2D. Both groups were characterized by a normal BMI, significant weight loss, and a short duration of hyperglycemic symptoms. However, LADA rarely presented with DKA and had higher HbA1c and insulin resistance during follow-up.
Authors
Luksameejaroenchai Luksameejaroenchai, Tangjarusritaratorn Tangjarusritaratorn, Preechasuk Preechasuk
View on Pubmed