β-Cell Protection and Therapy for Latent Autoimmune Diabetes in Adults

Latent autoimmune diabetes in adults (LADA) is a term used to describe a form of autoimmune diabetes that resembles type 1 diabetes, but has a later onset and slower progression toward an absolute insulin requirement. Controversies have been surrounding this concept and several attempts have been made to better characterize and classify it. But LADA still remains poorly understood and defined (1). It was even debated whether LADA exists as a distinct disease entity or it just represents the end of a wide spectrum of heterogeneous immune-mediated diabetes (2,3). Uncertainties concern almost all aspects of this disease, including the nomenclature, diagnostic criteria, epidemiology, natural history, and pathogenesis with genetic, metabolical, and immunological aspects. As a consequence, there is no clear management strategy for it, in terms of therapy and prevention. An ideal therapeutic approach would aim not only at obtaining a good metabolic control, but also at protecting residual β-cell mass and function. Even though ∼10% of adults with presumed type 2 diabetes at diagnosis in fact have LADA, only a few studies so far have evaluated therapeutic interventions for LADA, using a hypoglycemic or an immunomodulatory agent.