|Letters to the editor|
Medwave 2016 Ene;16(1):e6370 doi: 10.5867/medwave.2015.01.6370
Latent autoimmune diabetes of the adult: A new kind of diabetes?
Iván Garcia-Gomez, Ybis Lizarzaburu-Abanto, José Kelvin Galvez-Olortegui, Luis Camacho-Saavedra
Diabetes mellitus (DM) is one of the most relevant chronic diseases in global public health in the twenty-first century, being estimated 415 million adults approximately between 20 and 49 years old with diabetes mellitus worldwide in 2015 .
The Standards of Medical Care in Diabetes-2016 of the American Diabetes Association (ADA) classifies diabetes mellitus in type 1 diabetes, type 2 diabetes, gestational diabetes and other specific types of diabetes, not including latent autoimmune diabetes of the adult (LADA) . Latent autoimmune diabetes of the adult is a slowly progressive form of autoimmune diabetes that develops in adults ,. Nevertheless, it is not currently taken into account in the American Diabetes Association classification, despite being mentioned in different publications ,. Latent autoimmune diabetes of the adult is characterized by being treated at the beginning (the first six months after diagnosis) without insulin, in contrast to type 1 diabetes. In addition, latent autoimmune diabetes of the adult is positive for anti-GAD and anti-islet cell antibodies (ICA), unlike to type 2 diabetes (in which circulating antibodies are generally not found) . Latent autoimmune diabetes of the adult has common features with both type 1 and 2 diabetes, but also differs from these in genetic, immunological and metabolic aspects . It is also important to consider that even though diagnostics criteria for latent autoimmune diabetes of the adult have been raised , these are not universally applicable.
Since its appearance in medical literature, different authors and organizations consider to include latent autoimmune diabetes of the adult within different types of diabetes classification. Some studies suggest that patients with latent autoimmune diabetes of the adult tend to have worse glycemic control than patients with type 2 diabetes, thus generating a higher rate of complications, including mortality . Proper diagnosis of latent autoimmune diabetes of the adult and its inclusion within worldwide used classifications is of great importance, due to its impact on response to treatment and on prognosis of diabetic patients with specific medical conditions that do not fit in the classic categories of type 1 or 2 diabetics ; thereby preventing the associated complications to delayed diagnosis.
In summary, we consider necessary the standardization of latent autoimmune diabetes of the adult criteria and its inclusion within the classification of different organizations such as the American Diabetes Association; to achieve wider dissemination in the scientific community and a better therapeutic management of patients.
From the editor
Conflicts of interests
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