Genetics of latent autoimmune diabetes in adults (type 1.5 LADA diabetes)

This is an automatically translated article.

The article is expertly advised by MSc. Doctor Vu Thi Duyen - Doctor of Nephrology - Endocrinology, Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital.
Latent autoimmune diabetes is also known as type 1.5 diabetes or LADA diabetes. This type of diabetes has genetic features that are both similar to and different from type 1 diabetes and type 2 diabetes.

1. What is latent autoimmune diabetes in adults?

Previously, diabetes was divided into 4 main groups: type 1 diabetes, type 2 diabetes, gestational diabetes and other types of diabetes as secondary to taking drugs. However, that classification is still not the most complete classification today. There are several types of diabetes that are completely inappropriate to be classified under these groups because of their intertwined clinical and biological pathogenesis of type1 and type2. Therefore, the clinical course as well as the treatment did not completely follow the recommendations. Latent autoimmune diabetes in adults is one of these particular types that is currently of great interest.
Latent Autoimmune Diabetes of Adults (LADA) is also known as type 1.5 diabetes. It has the following characteristics:
It resembles type 1 diabetes in that: It has autoantibodies against islets of the pancreas (mainly GADA autoantibodies) but it usually has a later onset than it is found in People over 30 years old due to the destruction of pancreatic beta cell function gradually decrease over time. Therefore, treatment considers insulin supplementation only at certain stages, usually after 5 years (maybe the first time does not need treatment but control blood sugar by adjusting diet and oral medications).
It is similar to type 2 diabetes in that: It all starts at a later stage when the patient is over 30 years old, especially in those with risk factors for type 2 diabetes such as a history Family disease, obesity, overweight. Besides, the disease is similar to type 2 diabetes in that the function of beta cells remains for about 6 months to 5 years.

2. Genetic features of type 1.5 diabetes

It has the same genetics as type 1 diabetes: Both are related to the HLA-DRB1, PTPN22 and INS-VNTR genes.
It is genetically similar to type 2 diabetes: It is related to the TCF7L2 gene.
Thus, it can be seen that latent autoimmune diabetes in adults may be a genetic mix of type 1 and type 2 diabetes.
Some other genetic features of diabetes Type 1.5 diabetes:
HLA-DR3/4 is associated with a lower age of diabetes onset, HLA-DR3 is associated with positive GADA, HLA-DR4 is associated with positive IA-2A.
Clinical features of patients with type 1.5 diabetes are characterized by: High- and moderate-risk HLA genes are associated with earlier insulin therapy than those with low-risk HLA genes. .

Treatment characteristics in this disease tend to require additional insulin therapy or not depends on many other factors such as: The frequency of presence of autoantibodies (when the patient has higher levels of autoantibodies). The higher it is, the quicker insulin therapy is required because the faster the destruction of pancreatic cells leads to insulin deficiency), low body mass index, high leukocyte antigen groups, positive anti-TPO autoantibodies and especially Being female also increases the risk of early insulin treatment.
Therefore, latent autoimmune diabetes in adults should be diagnosed as early as possible. From there, we have a direction of early active treatment intervention that will ensure prevention of the risk of complications of the disease because diabetes has many acute and chronic complications. Therefore, those in the group at high risk of disease or having symptoms of the disease need to see a doctor soon for diagnosis and treatment.
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References: mayoclinic.org - diabetes.org.uk - hsph.harvard.edu