Decline pattern of beta cell function in LADA: Relationship to GAD autoantibodies

Authors: BACHA, FIDA - Children'S Nutrition Research Center (CNRC); REDONDO, MARIA - Texas Children'S Hospital

Submitted to: Journal of Clinical Endocrinology and Metabolism
Publication Type: Other
Publication Acceptance Date: 6/8/2020
Publication Date: 8/1/2020
Citation: Bacha, F., Redondo, M.J. 2020. Decline pattern of beta cell function in LADA: Relationship to GAD autoantibodies. Journal of Clinical Endocrinology and Metabolism. 105(8):e3008-e3009. https://doi.org/10.1210/clinem/dgaa374.
DOI: https://doi.org/10.1210/clinem/dgaa374

Interpretive Summary: Approximately 5 to 10% of adult onset diabetes and most cases of autoimmune diabetes diagnosed in adulthood is classified as latent autoimmune diabetes in adults (LADA). We need to better understand the factors that determine the loss of insulin production related to beta cell dysfunction in individuals diagnosed with LADA. This is important because it affects clinical treatment decisions such as requirement for insulin therapy. In this editorial, we reviewed the evidence in the literature and commented on research that evaluated the rate of progression of beta-cell function in Chinese adults diagnosed with LADA. The results of the study that evaluated 106 individuals with LADA, confirmed the importance of autoimmunity as predictor of the rate of beta cell failure and requirement of insulin therapy in individuals with LADA, the risk factors for rapid progression (younger age, lower BMI and lower FCP at diagnosis) consistent with features of autoimmune diabetes. The study adds to the literature in identifying a period of relatively rapid deterioration of beta cell function over 5 years followed by a more stable rate of decline. We highlighted some limitations of the study such as small sample size, single race-ethnicity, need for evaluation of other factors such as insulin sensitivity. We conclude that more efforts are needed in larger multiethnic cohorts to better define the different types of diabetes. It is likely that a combination of markers, including assessment of beta cell function, measures of autoimmunity and genetic profile, will provide the best model to allow individualized therapeutic intervention.

Technical Abstract: Approximately 5% to 10% of cases of adult onset diabetes and most cases of autoimmune diabetes diagnosed in adulthood (1, 2) are classified as latent autoimmune diabetes in adults (LADA). Identifying the determinants of the heterogeneous trajectory of betacell dysfunction in individuals diagnosed with LADA is important because it affects clinical therapeutic decisions, such as the requirement for insulin therapy. The study by Li et al contributes to the understanding of the rate of progression of beta-cell function in Chinese adults diagnosed with LADA.