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Latent Autoimmune Diabetes in Adults: Current Status and New Horizons

Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogen...

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Autores principales: Pozzilli, Paolo, Pieralice, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Endocrine Society 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021307/
https://www.ncbi.nlm.nih.gov/pubmed/29947172
http://dx.doi.org/10.3803/EnM.2018.33.2.147
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author Pozzilli, Paolo
Pieralice, Silvia
author_facet Pozzilli, Paolo
Pieralice, Silvia
author_sort Pozzilli, Paolo
collection PubMed
description Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA. To date the heterogeneity of LADA does not allow to establish a priori treatment algorithm and no specific guidelines for LADA therapy are available. These subjects are mostly treated as affected by type 2 diabetes, a factor that might lead to the progression to insulin-dependency quickly. A personalised medicine approach is necessary to attain optimal metabolic control and preserve β-cell function to decrease the risk of long-term diabetes complications. Recent data concerning the use of oral antidiabetic agents as dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists indicate up-and-coming results in term of protect C-peptide levels and improving glycaemic control. This review summarises current knowledge on LADA, emphasising controversies regarding its pathophysiology and clinical features. Moreover, we discuss data available about novel therapeutic approaches that can be considered for prevention of β-cell loss in LADA.
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spelling pubmed-60213072018-06-29 Latent Autoimmune Diabetes in Adults: Current Status and New Horizons Pozzilli, Paolo Pieralice, Silvia Endocrinol Metab (Seoul) Review Article Autoimmune diabetes is a heterogeneous disease which can arise at any age. Subjects with adult-onset autoimmune diabetes who do not necessitate insulin-therapy for at least 6 months after diagnosis are demarcated as having latent autoimmune diabetes in adults (LADA). This condition is more heterogeneous than young-onset autoimmune diabetes and shares clinical and metabolic characteristics with both type 2 and type 1 diabetes. Patients with LADA are considered by having highly variable β-cell destruction, different degrees of insulin resistance and heterogeneous titre and pattern of islet autoantibody, suggesting different pathophysiological pathways partially explaining the heterogeneous phenotypes of LADA. To date the heterogeneity of LADA does not allow to establish a priori treatment algorithm and no specific guidelines for LADA therapy are available. These subjects are mostly treated as affected by type 2 diabetes, a factor that might lead to the progression to insulin-dependency quickly. A personalised medicine approach is necessary to attain optimal metabolic control and preserve β-cell function to decrease the risk of long-term diabetes complications. Recent data concerning the use of oral antidiabetic agents as dipeptidyl peptidase 4 inhibitors and glucagon-like peptide 1 receptor agonists indicate up-and-coming results in term of protect C-peptide levels and improving glycaemic control. This review summarises current knowledge on LADA, emphasising controversies regarding its pathophysiology and clinical features. Moreover, we discuss data available about novel therapeutic approaches that can be considered for prevention of β-cell loss in LADA. Korean Endocrine Society 2018-06 2018-06-21 /pmc/articles/PMC6021307/ /pubmed/29947172 http://dx.doi.org/10.3803/EnM.2018.33.2.147 Text en Copyright © 2018 Korean Endocrine Society http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Pozzilli, Paolo
Pieralice, Silvia
Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title_full Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title_fullStr Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title_full_unstemmed Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title_short Latent Autoimmune Diabetes in Adults: Current Status and New Horizons
title_sort latent autoimmune diabetes in adults: current status and new horizons
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6021307/
https://www.ncbi.nlm.nih.gov/pubmed/29947172
http://dx.doi.org/10.3803/EnM.2018.33.2.147
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