Case Report| Volume 19, ISSUE 4, 104539, April 2023

A Case Report of LADA in the Primary Care Setting

Published:February 17, 2023DOI:


      • Latent autoimmune diabetes in adults (LADA) is under diagnosed in acute and primary care settings.
      • LADA is often mismanaged as type 2 diabetes.
      • All adults presenting with new diabetes should be screened for LADA.
      • Expert guidance on diagnosis and management of LADA now available.


      Latent autoimmune diabetes in adults (LADA), a slowly progressing form of autoimmune diabetes, accounts for 2%–12% of all diabetes. Pancreatic beta cell function eventually deteriorates, rendering the patient insulin dependent and at risk for serious complications. All newly presenting adult persons with diabetes should be screened for LADA. In particular, consider LADA in those adults with a personal or family history of autoimmune conditions or those persons diagnosed with type 2 diabetes initially controlled on evidence-based therapies but then become difficult to manage and exhibit signs, such as unintended weight loss, that are more typical of persons with type 1 diabetes.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal for Nurse Practitioners
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Naik R.G.
        • Palmer J.P.
        Latent autoimmune diabetes in adults (LADA).
        Rev Endocr Metab Disord. 2003; 4: 233-241
        • Kumar A.
        • de Leiva A.
        Latent autoimmune diabetes in adults (LADA) in Asian and European populations.
        Diabetes Metab Res Rev. 2017; 33: 5-19
        • Buzzetti R.
        • Tuomi T.
        • Mauricio D.
        • et al.
        Management of latent autoimmune diabetes in adults: a consensus statement from an international expert panel.
        Diabetes. 2020; 69: 2037-2047
        • Tuomi T.
        • Groop L.C.
        • Zimmet P.Z.
        • Rowley M.J.
        • Knowles W.
        • Mackay I.R.
        Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes in adults with non-insulin dependent onset of diabetes.
        Diabetes. 1993; 42: 359-362
        • DiMario U.
        • Irvine W.J.
        • Borsey D.Q.
        • Kyner J.L.
        • Weston J.
        • Galfo C.
        Immune abnormalities in diabetic patients not requiring insulin at diagnosis.
        Diabetologia. 1983; 25: 392-395
        • Bu D.F.
        • Tobin A.J.
        The exon-intron organization of the genes (gad 1 and gad 2) encoding two human glutamate decarboxylases (gad 67 and gad 65) suggests that they derive from a common ancestral gad.
        Genomics. 1994; 21: 222-228
        • Steffes M.W.
        • Sibley S.
        • Jackson M.
        • Thomas W.
        Beta-cell function and the development of diabetes-related complications in the diabetes control and complications trial.
        Diabetes Care. 2003; 26: 832-836
        • Carlsson S.
        Environmental (lifestyle) risk factors for LADA.
        Curr Diabetes Rev. 2019; 15: 178-187
        • Kobayashi T.
        • Nakanishi K.
        • Murase T.
        • Kosaka K.
        Small doses of subcutaneous insulin as a strategy for preventing slowly progressive beta-cell failure in islet cell antibody-positive patients with clinical features of NIDDM.
        Diabetes. 1996; 45: 622-626
        • Thunander M.
        • Thorgeirsson H.
        • Törn C.
        • Petersson C.
        • Landin-Olsson M.
        β-cell function and metabolic control in latent autoimmune diabetes in adults with early insulin versus conventional treatment: a 3-year follow-up.
        Eur J Endocrinol. 2011; 164: 239-245
        • Buzzetti R.
        • Zampetti S.
        • Maddaloni E.
        Adult-onset autoimmune diabetes: current knowledge and implications for management.
        Nat Rev Endocrinol. 2017; 13: 674-686
        • Awata T.
        • Shimada A.
        • Maruyama T.
        • et al.
        Possible long-term efficacy of sitagliptin, a dipeptidyl peptidase-4 inhibitor, for slowly progressive type 1 diabetes (SPIDDM) in the stage of non-insulin-dependency: an open-label randomized controlled pilot trial (SPAN-S).
        Diabetes Ther. 2017; 8: 1123-1134
        • Zhang Z.
        • Yan X.
        • Wu C.
        • et al.
        Adding vitamin D3 to the dipeptidyl peptidase-4 inhibitor saxagliptin has the potential to protect β-cell function in LADA patients: a 1-year pilot study.
        Diabetes Metab Res Rev. 2020; 36e3298
        • Dandona P.
        • Mathieu C.
        • Phillip M.
        • et al.
        Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes: the DEPICT-1 52-week study.
        Diabetes Care. 2018; 41: 2552-2559
        • Rosenstock J.
        • Marquard J.
        • Laffel L.M.
        • et al.
        Empagliflozin as adjunctive to insulin therapy in type 1 diabetes: the EASE trials.
        Diabetes Care. 2018; 41: 2560-2569
        • Perkins B.A.
        • Soleymanlou N.
        • Rosenstock J.
        • et al.
        Low-dose empagliflozin as adjunct-to-insulin therapy in type 1 diabetes: a valid modelling and simulation analysis to confirm efficacy.
        Diabetes Obes Metab. 2020; 22: 427-433
        • Danne T.
        • Garg S.
        • Peters A.L.
        • et al.
        International consensus on risk management of diabetic ketoacidosis in patients with type 1 diabetes treated with sodium-glucose cotransporter (SGLT) inhibitors.
        Diabetes Care. 2019; 42: 1147-1154
        • Agardh C.D.
        • Cilio C.M.
        • Lethagen A.
        • et al.
        Clinical evidence for the safety of GAD65 immunomodulation in adult-onset autoimmune diabetes.
        J Diabetes Complications. 2005; 19: 238-246


      Vera Barton-Maxwell, PhD, FNP-BC, is an assistant professor of advanced nursing practice at Georgetown University School of Nursing, Washington, DC, and a nurse practitioner at Wheeling Health Right, Inc, Wheeling, WV. She can be contacted at [email protected]