Background: Latent Autoimmune Diabetes of Adults (LADA) is a mild form of autoimmune diabetes which can be identified in 3-12% of adults who have a clinical diagnosis of T2D. LADA differs in genetic and clinical features with T2D, but whether this translates into a different risk for complications remains controversial.
Aim: We examined the long-term risk of microvascular complications in the large population with a clinical diagnosis of new-onset T2D enrolled into the United Kingdom Prospective Diabetes Study (UKPDS), according to their LADA status.
Methods: Islet-cell cytoplasm, glutamic acid decarboxylase and islet antigen-2 autoantibodies (AAb) were measured in 5028 UKPDS participants at, or soon after, T2D diagnosis. Those with ≥1 detectable AAb were defined as LADA and their incidence of a composite microvascular outcome (first occurrence of renal failure, renal death or diabetic retinopathy [blindness, vitreous haemorrhage or photocoagulation]), was compared with T2D participants.
Results: There were 564 (11.2%) of participants with LADA. Compared with T2D, they were younger, with higher mean HbA1c and HDL-cholesterol, but lower body mass index (BMI), total cholesterol and systolic blood pressure (SBP) (all p<0.01). The microvascular outcome occurred in 1041 (51.3%) of UKPDS participants during median 17.3 (range: 0.1-29.9) years follow-up. A time-varying cox-model showed a lower risk of microvascular events in LADA participants during the first nine years of follow-up (HR 0.52, 95% CI 0.35-0.78, p<0.01), but a higher risk beyond nine years (HR 1.47, 95% CI 1.20-1.81, p<0.01). These HRs were unchanged after adjustment for age, HbA1c, lipids, SBP, BMI, estimated glomerular filtration rate, smoking and UKPDS treatment arm.
Conclusions: The risk of microvascular complications in LADA patients differs over time, being lower in the earlier years after diagnosis but higher in later years compared with T2D, potentially impacting on their diabetic management.
E. Maddaloni: Speaker's Bureau; Self; Merck & Co., Inc., Pikdare. R.L. Coleman: None. R.R. Holman: Advisory Panel; Self; Bayer AG, Novartis AG, Novo Nordisk A/S. Research Support; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp. Other Relationship; Self; AstraZeneca, Bayer AG, GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc.
European Foundation for the Study of Diabetes