Diabetes: There's a New Kid on the Block

In today's day and age, it's hard to find someone who hasn't either known someone with diabetes or had it themselves. Diabetes affects 25.8 million Americans, or 8.3% of the US population [1].

Type 1 diabetes is an autoimmune condition that leads to destruction of the insulin secreting cells in the pancreas. Once enough of the pancreas is destroyed and they lose the ability to make insulin, these patients become dependent on insulin injections. Type 1 diabetics are generally diagnosed in childhood, and thus it is often called "juvenile" or "insulin dependent" diabetes. Type 1 diabetics makes up approximately 10-15% of the diabetic population in the US [2].

Type 2 diabetes is generally diagnosed later in life, and is the so-called "adult onset" diabetes, although with so many children being diagnosed now we are moving away from this terminology. Type 2 diabetes is caused by cellular resistance to the hormone insulin, and is completely mediated by dietary and lifestyle choices. Changing your dietary and lifestyle habits can reverse type 2 diabetes. For example, exercise stimulates insulin receptors on cells, and helps reverse the "insulin resistance" that is the fundamental pathophysiology of this disease. Type 2 diabetics make up the remaining 90% of those diagnosed with diabetes [2].

Research is now showing that there is a third form of diabetes what they are calling "type 1.5 diabetes", AKA "Latent Autoimmune Diabetes in Adults", or LADA. Most of the time these patients are misdiagnosed as having type 2 diabetes because of the timing of their diagnosis (adulthood). However, the disease process in LADA is closer to that of type 1 diabetes- it is also autoimmune. It has been estimated that anywhere from 2-20% of type 2 diabetics actually have LADA, making is about as common as type 1 diabetes [2]. These numbers vary from population to population, and to my knowledge there has not been any data on the percentages in the US.

Features of LADA that may help set it apart from type 2 diabetes include: [3]
1. Age of onset < 50 years (and usually >30)
2. Acute symptoms (increased thirst, increased urination, unintentional weight loss)
3. Body Mass Index (BMI) below 25 (normal body weight)
4. Personal history of another autoimmune disease
5. Family history of autoimmune disease

In a prospective study, the presence of at least two or more of these clinical features had a 90% sensitivity and 71% specificity for identifying LADA [3]. In other words, 90% of those with LADA were accurately identified according to these criteria, and 71% of people with at least two of these criteria did, in fact, have LADA.

Diagnosis of LADA relies on identifying GAD Antibodies, which is the single best marker for screening. While other pancreatic anti-bodies may be involved in LADA, GAD Ab testing shows a 76% sensitivity and 95.7% specificity at detecting LADA [3]. In other words, 95.7% of those who tested positive for GAD Abs had or will develop LADA, and 76% of those with LADA were GADA+. Other antibodies include islet cell Abs, Insulin Abs, and islet antigen 2 Abs.

But why is LADA not being screened for on a more regular basis... or at all? I would personally venture to guess that if you asked most doctors about LADA they wouldn't even know that it existed! The sad reality is that this diagnosis often has little clinical relevance to most doctors: They have no tools in their tool box to slow the progression of the autoimmune attack, so treatment is often unaffected by this diagnosis. As such, at this point in time it is not recommended in routine management of adult diabetic patients [3]. The recommended medical treatment for LADA is early insulin administration to help preserve beta cell function. Also, because of it's tenancy to further exhaust beta cells, sulfonylureas are not recommended for LADA patients [3].

Those of you who have been following my posts know that there is a LOT one can do to calm down the immune system and slow an autoimmune process. Things like eliminating dietary allergens, getting proper sleep, exercising, and boosting antioxidants such as glutathione and curcumin, and boosting vitamin D levels do wonders for the immune system and can help slow the progression of autoimmune diseases.

If anyone you know fits the above profile and is interested in getting screened for LADA, find a functional medicine doctor who is able to run tests by Cyrex labs. This lab has an autoimmune diabetes blood test that tests GAD, insulin and islet cell antibodies and is the best way available tool to properly diagnose LADA. I run Cyrex tests in my office in Tempe, Arizona. For more information my office can be reached at
(480) 280-3943 or you can visit my website at DrNicoleDiNezza.com.

In health, 

Nikki

References:
[1] http://diabetes.niddk.nih.gov/dm/pubs/statistics/#fast
[2] Brahmkshatriya P et al "Characteristics and prevalence of Latent Autoimmune Diabetes in Adults (LADA)" ISRN Pharmacology 2012 (PMID 22577577)
[3] Poudel R et al "Latent autoimmune diabetes of adults: from oral hypoglycemic agents to early insulin" Indian J of Endocrinol Metab 2012 March; 16 (PMID 22701843)