Introduction: Latent autoimmune diabetes in adults (LADA) is atypical heterogenic diabetes that is frequently misdiagnosed as type 2 diabetes (T2DM) . LADA can demonstrate features of type 1 or T2DM.1 The diagnosis of LADA is well established, however, there are no universally accepted treatment guidelines. Few studies report the impact of metformin on long-term management in LADA. Most LADA cases will ultimately require insulin treatment.2 This case highlights the importance of early diagnosis of LADA and the potential benefit of using metformin with lifestyle changes to help maintain glycemic control.

Case presentation: A 27-year-old man with no past medical history presented with unintentional weight loss (30 lbs.) , frequent urination, blurry vision and dry mouth for 3 months. Physical exam was unremarkable, body mass index (BMI) : 24.5. Blood sugar: 381 mg/dL, HbA1c: 14% and C peptide: 0.97 ng/ml. He was diagnosed with T2DM and started on metformin 500 mg twice a day. Due to high clinical suspicion for atypical diabetes (young age, normal BMI and profound hyperglycemia) , immunological tests were done (reference ranges in parentheses) . GAD 65 antibody: 37.5 IU/mL (< 5 IU/mL) , Islet cell antibody 1:16 (<1:4) and Zinc Transporter 8 antibody: 97.2 U/mL (< 15.0 U/mL) . The results were suggestive of LADA. The patient continued treatment with metformin, regular exercise and low carbohydrate/sugar intake. After a year of adherence with treatment, results showed normal C peptide, controlled fasting and post-prandial blood sugars demonstrated by continuous glucose monitoring, 1,5 anhydroglucitol:13ug/mL (10.7-32.0 ug/mL) and HbA1c: 5.3%.

Conclusion: Treatment with metformin combined with lifestyle changes appears to be beneficial in patients with LADA. This management has so far been able to preserve adequate beta-cell function, providing optimal glycemic control. Future studies are warranted to further evaluate the therapeutic mechanism of metformin in this patient population.


S.Velayati: None. M.Shanik: Consultant; Bigfoot Biomedical, Inc., Proteomics International, Research Support; Better Therapeutics, Speaker's Bureau; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk, Xeris Pharmaceuticals, Inc. I.J.Romao: None.

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