Diabetes: are the new drugs also effective for the Lada type?

I suffer from “Lada” type diabetes and I have heard about new drugs, for example in the form of a weekly injection. Are they also suitable for my type of diabetes?

He replies Marco Comogliodiabetologist, Association of Diabetologists (GO TO THE FORUM)

The diabetes «Lada» (latent autoimmune diabetes of adults) is a slowly progressive autoimmune form which, in Italy, affects approximately 5% of adults with a previous diagnosis of type 2 diabetes mellitus. Lada begins in adulthood (> 30 years) with a deterioration of beta-cell function, consequence of progressive damage to the pancreas induced by autoantibodies. Since the progression of the damage is slow, it does not initially require insulin treatment (within 6 months of diagnosis), unlike type 1 diabetes mellitus which requires insulin therapy immediately. The Lada is frequently not recognized because, appearing in adulthood, is mistaken for type 2 diabetes.

Exams

The diagnosis is made by determining the presence of autoantibodies – GADA (anti-glutamic acid decarboxylase antibodies), IA-2A (anti-tyrosine phosphatase antibodies), ZnT8A (anti-zinc transporter 8 antibodies) e IAA (anti-insulin antibodies) – e the evaluation of beta-cell functionality, by measuring basal and post-stimulus C-peptide. The positivity of even just one of the antibodies listed allows for the diagnosis of Lada, while the evaluation of the beta-cell function allows for the evaluation the degree of progression of the disease damage. As in all forms of diabetes, the first step of therapy is a correct lifestyle with aerobic physical activity and a Mediterranean-style dietwith limitation of simple sugars.

Drugs

Pharmacological therapy of choice, when necessary, is insulin even at low doses. The new drugs (DPP IV and GLP1-RA) have proven effective and so have SGLT2i they could be a good therapeutic option, but to date there are few studies on the use of these drugs in Lada. In particular, regarding dulaglutide (weekly injection)phase 3 studies (AWARD-2, -4 and -5) were evaluated: they showed that dulaglutide significantly reduced HbA1c (glycated hemoglobin) levels and increased markers of beta-cell function in Lada patients. However, large-scale studies with long-term follow-up are needed to confirm the efficacy of GLP1-RAs in preserve metabolic control and in delaying progression to insulin dependence in Lada-type diabetes.

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