Risks From Latent Autoimmune Diabetes in Adults Resemble Those for T2D Risks From Latent Autoimmune Diabetes in Adults Resemble Those for T2D

Researchers published the study covered in this summary on Preprints with The Lancet as a preprint that has not yet been peer reviewed.

Key Takeaways

  • The risks of death and cardiovascular disease (CVD) in people with latent autoimmune diabetes in adults (LADA) were comparable to that of people with type 2 diabetes.

  • The risk of diabetic retinopathy was higher in people with LADA compared to people with type 2 diabetes.

  • LADA is characterized by worse glycemic control than type 2 diabetes, particularly in those with high levels of glutamic acid decarboxylase antibodies (GADA).

Why This Matters

  • LADA is a hybrid form of diabetes that has characteristics of both type 1 diabetes, such as autoimmunity, and type 2 diabetes, such as insulin resistance.

  • Glycemic control is worse in people with LADA compared to people with type 2 diabetes, possibly due to insufficient endogenous insulin production and lack of established treatment guidelines. The upshot is that people with LADA have an increased risk for vascular complications.

  • LADA accounts for 3%-12% of all adult-onset diabetes but its prognosis has not been well-studied. This is one of the largest reported prospective studies of LADA.

Study Design

  • The study used prospective data from the Swedish ANDIS registry in 2007-2019. It included 550 people with newly diagnosed LADA, 2001 people with newly diagnosed adult-onset type 2 diabetes, and 2355 people without diabetes included as controls. The study also included 1672 people with adult-onset type 1 diabetes from ANDIS and anther Swedish diabetes registry.

  • Those with LADA were divided into two subgroup with a low (below the median) or high GADA level (above the median).  

Key Results

  • During a median follow-up of 5.9 years, there were 402 deaths (including 49 people with LADA), 323 people had CVD events (including 35 people with LADA), 79 had nephropathy events (10 among those with LADA), and 190 had retinopathy events (74 in those with LADA).

  • People with LADA or type 2 diabetes had significantly higher mortality rates than controls, with a relative increase of 53% and 36%, respectively.

  • Significant excess mortality only occurred among people with both LADA and low GADA levels, an increased rate of 86% relative to controls.

  • No significant difference in mortality occurred between people with LADA and those with type 2 diabetes.

  • CVD incidence was significantly elevated in people with LADA and high GADA levels, with a 67% increase relative to controls, and those with type 2 diabetes, with a 53% increase compared with controls. CVD incidence was not significantly different in those with LADA and low GADA levels or those with type 1 diabetes compared with controls.

  • People with LADA and low or high GADA levels had significantly higher rates of retinopathy that were more than double that of controls.

  • The proportion of people that reached the A1c target of < 7% declined with diabetes duration among all diabetes types. Ten years after diagnosis, the A1c target was met by 31% of those with LADA and high GADA levels, 32% of those with type 1 diabetes, 43% of those with LADA and low GADA levels, and 58% of those with type 2 diabetes.

  • Within 6 months of diagnosis, the proportion of patients who required insulin was 42% of those with LADA and high GADA levels, 28% of those with LADA and low GADA levels, and 5% of those with type 2 diabetes. By 10-year follow-up, these rates had increased to about 80%, 60%, and 20%, respectively.

Limitations

  • Available data for the controls without diabetes was not as complete as it was for those with some form of diabetes.

  • The number of people studied was relatively small, and the generalizability of the findings is uncertain.

Disclosures

This is a summary of a preprint research study, “All-cause mortality, cardiovascular and microvascular diseases in latent autoimmune diabetes in adults,” by researchers affiliated with the Karolinska Institute and Malmo University in Sweden on Preprints with the Lancet and provided to you by Medscape. The study has not yet been peer-reviewed. The full text of the study can be found on https://www.ssrn.com/index.cfm/en/the-lancet/.