Progress in the characterization of slowly progressive autoimmune diabetesin adult patients (LADA or type 1,5 diabetes)

LADA or type 1.5 diabetes is a slowly progressive form of autoimmune diabet es of adults and represents a considerable proportion (about 5-10%) of all diabetic patients. Associations with high risk HLA genotypes and autoimmune phenomena (GAD, IA2, ICA) show similarities with type 1 diabetes, but phen otypical characteristics of these patients do not allow the correct identif ication without screening of GAD antibodies. The relatively low antibody ti ters against islet-cell antigens in LADA patients may be sign of a less agg ressive form of autoimmune diabetes and could be responsible for the-long n on-insulin requirement phase of this diabetes type. Similar as in prediabet ic relatives of type 1 diabetic patients the risk for beta cell failure in adult "type 2 diabetic" patients increases with the number of antibodies po sitive. Consequently, low titers of GAD - in particular in elderly patients - do not predict a progressive and rapid-loss of beta-cell failure, when a ssociations with highrisk genotypes or other islet-cell antibodies are lack ing. Patients with LADA share insulin resistance with type 2 diabetic patie nts, but display a more severe defect in stimulated beta-cell capacity than patients with classical type 2 diabetes. With respect to features of the m etabolic syndrome, patients with LADA have lower BMI blood pressure and tri glyceride levels compared with classical type 2 diabetes patients. Early id entification of LADA patients will be mandatory, when effective immune inte rventions are available for prevention of the beta-cell destructive process insulin requirement of these patients.