Should My Sons Be Tested for LADA?
I was diagnosed with LADA in 2010, and my A1C continued to increase until I began insulin injections. Is LADA, or any type of diabetes, something my young adult sons should be tested for? Are they more at risk? Until me, there was no history of diabetes in our family. Katie Atkinson, Alma, Michigan
Sue Kirkman, MD, responds:
You raise two issues about LADA: misdiagnosis and screening of relatives.
What to Know
LADA (latent autoimmune diabetes in adults) is a slow-onset form of type 1 diabetes diagnosed in adulthood. Unfortunately, a common misconception is that type 1 diabetes is always “juvenile-onset,” or diagnosed only in children, so any diabetes diagnosis in an adult must be type 2.
Find Out More
Children usually get very sick quickly before they are diagnosed with type 1 and start on insulin. In adults, type 1 tends to come on more slowly, and insulin may not be needed for months or even years. Some experts call all type 1 that is diagnosed in adults LADA, while others reserve the term for the very slow-to-develop cases. So it is difficult to know how many cases of diabetes are LADA. The autoantibodies (antibodies attacking the insulin-producing cells in the pancreas) and the genes associated with LADA seem to be the same as for “classic” type 1.
Reasons to consider type 1/LADA in an adult with diabetes include the person not being overweight, lack of family history of diabetes (80 to 90 percent of type 1s have no family history; most type 2s do), other autoimmune disease in the person or family, and high blood glucose readings not responding (initially or over time) to standard medications for type 2.
Your sons are more likely than others to develop type 1/LADA, but their risk is probably still very low. Periodic testing is recommended to screen for type 2, which is very slow in onset, but may not work for type 1 (whether it would help identify LADA as it slowly develops is not clear). The government-funded TrialNet program screens family members of those with type 1 by measuring blood samples for autoantibodies, which are a strong predictor of developing type 1 diabetes.
Testing an adult for type 1 autoantibodies may help clarify things when the case isn’t “classic.” Family members of people with type 1/LADA may want to contact TrialNet (diabetestrialnet.org) for more information about screening.