A new ADA position paper on managing Type 2 diabetes advises considering the possibility of LADA in lean "Type 2" patients. Progress! While ADA only mentions measuring anti-GAD, it is important to test for all antibodies (GAD, ICA, IA-2, zinc transporter), because there is a significant percentage of LADAs (and any Type 1s) who are only ICA positive. Also, a number of TuD members have found that LADA is not exclusive to lean individuals. Those with LADA who are "no longer at fighting weight" are sadly far more likely to be misdiagnosed. Here is an excerpt from the position statement:
"In lean patients, consideration should be given to the possibility of latent autoimmune diabetes in adults (LADA), a slowly progressive form of type 1 diabetes. These individuals, while presenting with mild hyperglycemia, often responsive to oral agents, eventually develop more severe hyperglycemia and require intensive insulin regimens (106). Measuring titres of isletassociated autoantibodies (e.g., anti-GAD) may aid their identification, encouraging a more rapid transition to insulin therapy."
Thanks for posting this Melitta. Cheers! Joanne
Thanks as well for posting the link!
It seems sort of silly that they'd advise "considering the possibility of LADA in lean 'Type 2' patients". If there are around 5-6 billion of us, it seems more reasonable to conclude that there'd be LADA appearing in all cohorts? Doctors and insurance companies should suck it up and do the testing as early as possible to make sure that they correctly identify the nature of the pathology before they treat it, rather than treating by throwing metformin "spaghetti" at the wall to see if it sticks?
A step in the right direction!
In agreement once again. Lets just hope it's not the only step. By limiting testing to only thin types there is still a lot of LADA's that will be missed.
I don't understand why Primary Care Providers are so ignorant and oblivious to the LADA phenomenon. It almost seems like they are only prepared to deal with type 2 diabetes in the old. I once went to a clinic where the only literature they had in pertinence to diabetes was for Type 2. When I went in for an exam the first thing a nurse asked was if I was sure I really had it.
That is basically what the average LADA is up against when trying to get proper health care and it really makes me livid.
Just because you are still making insulin they come to the conclusion that you can just take metformin until your pancreas collapses.
Uhm, the goal should be to keep pancreatic function as long as possible hence the reason for insulin.
I asked my PCP for insulin everytime I went and she found EVERY excuse imaginable to keep it away. I went to my first trip to an endo (that I found myself) and he put me on insulin straight away and my BG's were better (well I spiked today. But it was because of these toffee coated peanuts that I'll never eat again).
I think the goal should be to normalize BG? That's more challenging but if you aim at that, you're more likely to hit it?
Hi Type2Tommy: It's not just LADAs who still make some endogenous insulin--it's almost all Type 1s. It is the rare Type 1 who does not, at almost any age. I have never understood the head-in-the-sand mentality, but I did try to tackle the issue in my "Doctors Behaving Irrationally" blog. Note that my blog has an American Family Physician reference that discusses LADA.
I had one GP who insisted that I couldn't possible have T1/LADA because those patients always presented in the emergency room (ER). She also had no idea how to use antibody test for diagnosis, nor much clue about what c-peptide meant. Obviously, in her case, all the T1/LADA patients were properly diagnosed only in the ER.
I listened in on a newly diagnosed diabetic as she was told by her Endo, "that she was definately type 2 because the oral meds were working" Did I happen to mention the patient is slim, no history of prediabetes, and being treated by this very same Endo for Hashimoto's?
Progress, albeit somewhat limited. Thanks Melitta!
Good to see it addressed.
YES! I am happy to hear this. As a "lean" type 2 diabetic it was very frustrating and downright dangerous to be put on oral meds that didn't work. Just hope the word can spread in the medical community fast enough.