CHALLENGES IN THE DIFFERENTIAL DIAGNOSIS OF DIABETES MELLITUS IN ADULTS: A CASE REPORT OF THE LADA PHENOTYPE
DOI:
https://doi.org/10.32689/2786-7161-2026-2-4Keywords:
Latent Autoimmune Diabetes in Adults, autoantibodies, C-peptide, differential diagnosisAbstract
Background. Latent Autoimmune Diabetes in Adults (LADA) is a distinct form of the disease that often presents under the clinical mask of type 2 diabetes mellitus (T2DM). Aim. To demonstrate the clinical importance of immunological and secretory assessment in patients with a normosthenic body habitus for the verification of latent autoimmune diabetes in adults, and to evaluate the effectiveness of intensified insulin therapy using insulin analogs in the management of severe glycemic decompensation. Case Presentation. We present the clinical case of patient M., 55 years old, with a 9-year history of diabetes. Due to the misclassification of the condition as T2DM, the patient received inadequate glucose-lowering therapy for an extended period, resulting in severe decompensation (glycated hemoglobin (HbA1c) level of 13.8%), the risk of developing a ketoacidotic state, and the progression of diabetic neuropathy. Methods. Comprehensive clinical assessment included autoantibody testing for β-cell antigens and C-peptide measurement. Patients underwent expanded screening for comorbid autoimmune thyroid pathology. Glucose-lowering therapy was transitioned to an intensified basal-bolus regimen using insulin analogs, with clinical and metabolic parameters evaluated over a 3-month follow-up. Results. Latent autoimmune diabetes in adults was verified. Intensified basal-bolus insulin therapy significantly improved glycemic control within three months without hypoglycemia. Conclusions. Differential diagnosis in normosthenic adults requires mandatory autoantibody and C-peptide testing. Timely insulin initiation preserves residual beta-cell function, prevents ketoacidosis, and slows vascular complication progression.
References
American Diabetes Association Professional Practice Committee for Diabetes. (2026). Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl. 1), S183–S215. https://doi.org/10.2337/dc26-S009
Badenhoop, K. (2015). Genetics of Autoimmune Thyroiditis in Type 1 Diabetes Reveals a Novel Association With DPB1*0201: Data From the Type 1 Diabetes Genetics Consortium. Diabetes Care, 38(Suppl. 2), S21–S28. https://doi.org/10.2337/dcs15-2005
Buzzetti, R., Tuomi, T., Mauricio, D., Pietropaolo, M., Zhou, Z., Pozzilli, P., & Leslie, R. D. (2020). Management of latent autoimmune diabetes in adults: A consensus statement from an international expert panel. Diabetes, 69(10), 2037–2047. https://doi.org/10.2337/dbi20-0017
Carlsson, S. (2019). Etiology and pathogenesis of LADA compared to type 1 and type 2 diabetes. Frontiers in Physiology, 10, 320. https://doi.org/10.3389/fphys.2019.00320
Chandran, L., Singh, S. A., & Vellapandian, C. (2023). Diagnostic dilemmas and current treatment approaches in latent onset autoimmune diabetes in adults: A concise review. Current Diabetes Reviews, 19(1), Article e240322202561. https://doi.org/10.2174/1573399818666220324095918
Fain, P. R., Baker, P., Eisenbarth, G., & Frommer, L., & Kahaly, G. J. (2020). Type 1 diabetes and associated autoimmune diseases. World Journal of Diabetes, 11(11), 527–539. https://doi.org/10.4239/wjd.v11.i11.527
Holt, R. I. G., DeVries, J. H., Hess-Fischl, A., Hirsch, I. B., Kirkman, M. S., Klupa, T., Ludwig, B., Nørgaard, K., Pettus, J., Renard, E., Skyler, J. S., Snoek, FJ., Weinstock, R. S., & Peters, A. L. (2021). The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 64(12), 2609–2652. Erratum in: Diabetologia, 65(1), 255. https://doi.org/10.1007/s00125-021-05568-3
Hu, J., Zhang, R., Zou, H., Xie, L., Zhou, Z., & Xiao, Y. (2022). Latent Autoimmune Diabetes in Adults (LADA): From immunopathogenesis to immunotherapy. Frontiers in Endocrinology, 13, 917169. https://doi.org/10.3389/fendo.2022.917169
Jones, A. G., McDonald, T. J., Shields, B. M., Hagopian, W., & Hattersley, A. T. (2021). Latent Autoimmune Diabetes of Adults (LADA) Is Likely to Represent a Mixed Population of Autoimmune (Type 1) and Nonautoimmune (Type 2) Diabetes. Diabetes Care, 44(6), 1243–1251. https://doi.org/10.2337/dc20-2834
Fourlanos, S., Dotta, F., Greenbaum, C. J., Palmer, J. P., Rolandsson, O., Colman, P. G., & Harrison, L. C. (2006). A clinical scoring system identifies adults with type 1 diabetes who are likely to have latent autoimmune diabetes in adults (LADA). Diabetes Care, 29(5), 970–975. https://doi.org/10.2337/diacare.295970
Kahles, H., Krischer, J. P., Liu, X., Lernmark, Å., Hagopian, W. A., Rewers, M. J., She, J. X., Toppari, J., Ziegler, A. G., Akolkar, B., & TEDDY Study Group. (2022). Predictors of the initiation of islet autoimmunity and progression to multiple autoantibodies and clinical diabetes: The TEDDY Study. Diabetes Care, 45(10), 2271–2281. https://doi.org/10.2337/dc21-2612
Leslie, R. D., Evans-Molina, C., Freund-Brown, J., Buzzetti, R., Dabelea, D., Gillespie, K. M., Goland, R., Jones, A. G., Kacher, M., Phillips, L. S., Rolandsson, O., Wardian, J. L., & Dunne, J. L. (2021). Adult-onset type 1 diabetes: Current understanding and challenges. Diabetes Care, 44(11), 2449–2456. https://doi.org/10.2337/dc21-0770
Lundholm, M. D., & Zhou, K. (2025). Latent autoimmune diabetes in adults: Not type 1, not type 2, a little of both. Cleveland Clinic Journal of Medicine, 92(12), 757–763. https://doi.org/10.3949/ccjm.92a.25069.
Luo, S. M., Liu, BW., Yin, W. F., Li, X., & Zhou, Z. G. (2021). A long and winding road to understand latent autoimmune diabetes in adults. Chinese Medical Journal, 134(1), 1–4. https://doi.org/10.1097/CM9.0000000000001321
Maddaloni, E., Moretti, C., Mignogna, C., & Buzzetti, R. (2020). Adult-onset autoimmune diabetes in 2020: An update. Maturitas, 137, 37–44. https://doi.org/10.1016/j.maturitas.2020.04.014
Pashkovska, N., & Tsaryk, I. (2024). Latent autoimmune diabetes in adults: current data (review of literature and own data). International Journal of Endocrinology (Ukraine), 20(3), 163–172. https://doi.org/10.22141/2224-0721.20.3.2024.1384
Ravikumar, V., Ahmed, A., & Anjankar, A. (2023). A review on latent autoimmune diabetes in adults. Cureus, 15(10), e47915. https://doi.org/10.7759/cureus.47915
Santoso, C., Wei, Y., Ahlqvist, E., Tuomi, T., & Carlsson, S. (2025). Autoimmune diseases and the risk and prognosis of latent autoimmune diabetes in adults. Diabetologia, 68(2), 331–341. https://doi.org/10.1007/s00125-024-06303-4
Wang, W., Huang, F., & Han, C. (2023). Efficacy of regimens in the treatment of latent autoimmune diabetes in adults: A network meta-analysis. Diabetes and Therapy, 14(10), 1723–1752. https://doi.org/10.1007/s13300-023-01459-5.
Wang, Z., Zhang, J., Xu, H., Chen, L., & Dove, A. (2021). Development and validation of a prevalence model for latent autoimmune diabetes in adults (LADA) among patients first diagnosed with type 2 diabetes mellitus (T2DM). Medical Science Monitor, 27, Article e932725. https://doi.org/10.12659/MSM.932725
