What Is LADA / 1.5 Diabetes?

When an adult is diagnosed with diabetes, it is often automatically assumed that they have type 2 diabetes. However, not every adult who gets diabetes has type 2. Some of them have a form of the disease called latent autoimmune diabetes in adults (LADA). Many people with LADA are misdiagnosed, which can have serious consequences.^1-4

What is LADA?

Diabetes is a long-term condition where the body has a problem making or using insulin. The 2 most common forms are type 1 and type 2 diabetes. In type 1, the immune system destroys the cells that make insulin. This is usually diagnosed in childhood or adolescence. Type 2 is typically diagnosed in adults who may be overweight or obese and have high blood sugar because their body is not able to use insulin well.¹

LADA is less common than the other types, but it may affect up to 12 percent of people with diabetes. It has similarities with both type 1 and type 2 diabetes, so it is sometimes called type 1.5 diabetes. On a clinical level, it is most like type 1 diabetes because they are both autoimmune conditions.^2,3

How is LADA different from type 1 and type 2 diabetes?

Unlike traditional type 1 diabetes, people with LADA are often not diagnosed until they are over 30. But, they both involve autoimmune reactions to certain antibodies. People with LADA are also less likely to be overweight than those with type 2 diabetes.⁴

In general, LADA might be suspected in people who are a normal weight, are not insulin resistant, and do not have a family history of diabetes.²

Unfortunately, LADA is often misdiagnosed as type 2 diabetes. LADA usually causes higher blood sugars than type 2 diabetes. It also tends to progress quickly and requires insulin sooner.^2,3

How is LADA diagnosed?

The similarities between LADA and the other more common types of diabetes make it hard to diagnose. Another issue is lack of awareness both in the public and with healthcare providers. This can lead to misdiagnosis and incorrect treatment.⁴

The help avoid this, there are 3 key traits that doctors will look for to diagnose LADA:^3,4

1. Age 30 or older
2. Testing positive for certain antibodies
3. Needs insulin therapy much more rapidly

What happens if LADA is misdiagnosed?

Each type of diabetes is treated differently so it is important to have the correct diagnosis.² The wrong diagnosis can make it harder to manage the disease. It can also increase the risk of complications like ketoacidosis, a serious condition where the blood acid (ketones) levels get too high.^1,4

When people with LADA are misdiagnosed, they are often given the same oral medications that are used to control blood sugar for type 2 diabetes. But those medications do not usually work well for people with LADA.³ Delays in getting the correct treatment may make it harder to save the body’s ability to keep making insulin. Getting the right diagnosis is critical for people with LADA.^3,4

How is LADA treated?

The goals of treating LADA are to avoid long-term complications by:⁴

• Preserving as many of the cells that create insulin as possible, and
• Controlling blood sugar

Insulin therapy is almost always required for people with LADA. Not only does it control blood sugar, but it also works to keep the disease from getting worse.^3,4 A dipeptidyl peptidase 4 (DPP-4) inhibitor, known as a “gliptin”, is another class of drug that is often used for LADA. It helps that body make more of its own insulin.⁴