Approach to Diagnosis and Management Latent Autoimmune Diabetes in Adults: A Case Report

Introduction:. Latent Autoimmune Diabetes in Adults (LADA) is used to describe a form of autoimmune diabetesthat has a later onset and a slower progression toward an absolute insulin requirement. The presence of pancreaticauto antibodies especially to Glutamic acid decarboxylase (GAD65) is the best single marker required to diagnoseLADA. Case Illustration. A 35-year-old male came to emergency room with complaints of shortness of breath since twodays before admission. Tightness was not affected by activities or changes in position. The patient also hadcomplaints of vomiting since 3 days before admission. There was a weight loss of 10 kg in the last 1 month andcomplaint urinated frequently. There is no family history of diabetes and autoimmunity. The patient’s blood sugarlevel was 422 mg/dL, blood ketone was 5.6 mmol/L, and the blood gas analysis showed metabolic acidosis. The c-peptide level was 0.35 ng/mL (1.1 - 4.4 ng/mL). Patients was positive for glutamic acid decarboxylase (GAD)autoantibodies. Patients was diagnose with LADA and treated with basal insulin 1x36 unit and prandial insulin 3x20unit. Discussion: C-peptide is mostly undetectable in classical T1DM and normal or high in patients with newlydiagnosed T2DM, whereas individuals with LADA tend to have low but still detectable C-peptide values at the timeof diagnosis. Thus, islet autoantibodies screening, especially GADA, should be required as a second step for patientswith adult-onset diabetes showing low serum C-peptide. To date, evidence shows that patients with LADA shouldbe treated with insulin at an earlier stage. Conclusion: Routine GADA screening should be considered. However, since testing for islet-cell autoantibodiesmay not always be indicated because of high costs, C-peptide measurement may be a useful tool to rule outdiagnosis of LADA in case of low clinical suspicion.