Latent autoimmune diabetes (LADA): an overview of current therapeutic management

Abstract

Introduction: Diabetes mellitus, which is rapidly rising globally, includes several forms, such as T1D, T2D, and latent autoimmune diabetes in adults (LADA). LADA, estimated to affect 3% to 11% of the diabetic population, was officially recognized by the WHO in 2019 and classified as a subtype of T1D in 2022. With genetic characteristics of T1D and manifestations of T2D, LADA is often confused with T2D, making proper diagnosis and treatment difficult. Objective: This study aims to discuss the main treatment methods for LADA, contributing to the knowledge and improvement of therapeutic strategies for this specific form of autoimmune diabetes. Methodology: An integrative literature review was carried out by searching the PubMed and Cochrane databases. Ten articles were selected that met criteria such as publication in the last five years, rigorous methodology, and relevance to the therapeutic management of LADA. The articles were analyzed and discussed in their main aspects. Results and Discussion: Treatment of LADA focuses on delaying pancreatic beta-cell apoptosis and improving metabolic control. Insulin, in addition to regulating blood glucose, has immunomodulatory properties that protect beta cells. DPP-4 inhibitors, such as sitagliptin, in combination with vitamin D, have shown promise in delaying disease progression. In addition, emerging approaches, such as modulation of the autoimmune response by the GADA antibody and interventions in the intestinal microbiota, are areas of increasing interest but require further investigation. Other therapies, such as GLP-1RAs and SGLT2is, have shown potential, although they have not yet been widely studied in the context of LADA. Conclusion: The lack of standardization in the treatment of LADA hinders effective management. However, the use of insulin, DPP-4 inhibitors and vitamin D demonstrates efficacy. Additional studies are needed to explore new therapies and preventive strategies to improve the treatment of LADA.