Latent autoimmune diabetes in adults: The search for interventions continues

This Practice Point commentary discusses the findings of a study by Maruyama et al., in which treatment with insulin was compared to sulfonylurea in 60 patients with slowly progressive insulin-dependent diabetes mellitus (SPIDDM), a presumed form of latent autoimmune diabetes in adults (LADA). Patients who received insulin had a lower rate of progression to insulin dependency than patients who received sulfonylurea (10% versus 43%, P = 0.003). Here, I review the history of LADA and the current approach to diagnosis and treatment. Diagnosis of LADA is generally by the detection of glutamic acid decarboxylase antibodies in adults who present with the clinical features of type 2 diabetes mellitus, providing presumptive evidence of autoimmunity. Treatment of LADA is usually with insulin, an approach supported by the findings of the study. Nonetheless, some evidence suggests that sulfonylurea actually accelerates loss of β-cell function. Whether this effect had a role in the results obtained by the Maruyama et al. is not yet clear.