I've also read literature, especially from the UK that makes this distinction.
However, 1.5 has to have the autoimmune component too, but also can have features of T2.
Lots of literature doesn't make the distinction, but also talks about LADA having some features of T1 & T2, where I guess the T2 part comes in when you can still take oral meds and they do make a small difference for a short while. Some meds work directly on insulin resistance, and some work on making the body pump out more insulin. If you are thin, I'd expect only the second of those to have any measurable effect for a short while. If you do have insulin resistance, then both types of meds would work for a while.
The problem with this is that some people with LADA/T1.5 may only have GAD antibodies, whereas others have GAD another other antibodies, which apparently makes them insulin dependent sooner.
The distinction, if there is one to be made, in my humble opinion, isn't clear. It depends entirely on what you're reading and by whom it was written.
T1s can also develop insulin resistance after a certain age - do they then get called T.5? No!
The problem is that many LADA/T1.5 cases are diagnosed at an age where insulin resistance comes into play anyway.
LADA/T1.5, like T1s become insulin dependent because their beta cells are destroyed by antibodies. T2s have no antibodies (as far as we know at this point in the science) so if they become insulin dependent, it's for other reasons.
LADA or T1.5, in Australia, is still classified as a variant of T1. It's a slow onset T1 that may or may not have insulin resistance as well. At this point, I think some of the medical community makes the terms interchangeable.
Thanks, Susi, for a comprehensive response! I assumed an autoimmune component in 1.5 and LADA. But I also assumed that since onset is in adults, there would be some expected component of resistance, so did not understand why the distinction.
I am more used to reading peer-reviewed journal articles, where terminology is used more precisely. I tend to assume MDs are held to the same high standards (not sure why; guess I thought the literature vs. texts about autism for clin psychs was an exception!). Small wonder our book circulation is declining over the past decade, in my library. It must be terribly frustrating to be constantly contradicted after reading it in "your" book. Let alone, by patients! ;-D
I was once a Medical Editor and I am no doctor. I could have made that same mistake in all the patient information (PI) and other literature I edited. It's all paid for by the pharmaceutical industry and as long as it reads like you know what you are talking about, they will print it and bind it and sell their strips! I wrote a few PI's, in fact. I even edited articles for doctors who could care less and just wanted to get paid by the drug lords. As long as it sounds good. It was a brilliant jumble of guesswork. And. I. Was. Clueless.
As is the NIH, apparently. One study that they "supposedly" did on Stiff Man Syndrome (for the purpose of studying an overpriced harmful drug, of course) stated in the Inclusion Criteria: only those with "elevated anti-GAD antibodies" and "Patients with Diabetes (Type II) will be allowed to participate because up to 40% of SPS [or SMS, same thing - Stiff Person v. Stiff Man] patients have Diabetes." Crazy, huh? SMS'ers are LADA's, mostly, which perhaps explains their gross mistake. I got LADA after SMS, but other SMS'ers got LADA first. That's confusing. Sorry. I'm trying to say... If someone has SMS and happens to IR, there is no "link." They would have 2 separate diseases. Then again, I always get sudden onset and SMS'ers could be dx'ed with IR before LADA. I know nothing. Unfortunately, the NIH knows less than nothing. They also wrote Apheresis instead of Plasmapheresis! High-larious!
But then, let's not forget who pays for these studies. The things I made up... wow! I thought I was a genius. Swear. Oncology and endocrinology were my faves. I could never get my head around tardive dyskenesia, tho... It's always in the list of side effects:-] Then again, maybe I was a genius b/c they printed my "sounds right" crap.
I'm loving Latent Autoimmune Diabetes "Aging". Some poor temp med-editor was doing overtime that day!
I read this distinction in one of those handbooks -- the ones medical students rely heavily upon, fits in a labcoat pocket, which might turn it into a sort of "folklore" that will become mainstream. I was just curious as to where it had originated -- from a practitioner or an actual theorist!
It might not be "official" with the powers that be, but Joslin's certainly refers to LADA, and there are certain practical considerations that set it apart -- the need for more gradual -- but early -- use of an insulin regimen, for instance.
There may be no official definition of Type 1.5, but I do know that Professor Paul Zimmet of the International Diabetes Institutes (in Australia) coined and defined the term. I recently read what year that was, but my sieve of a brain can't recall. Somewhere in the 1990s, I think.
I wonder which term, LADA or 1.5, will eventually stick. Or will we forever have to write and say "LADA/T1.5"?
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