Latent autoimmune diabetes in adults: a guide for the perplexed

Excerpt

Diabetes rejoices in silly names. Maturity-onset diabetes of the young (MODY) is no doubt the silliest, but—for reasons that will emerge—latent autoimmune diabetes in adults (LADA) comes close. There is, however, one important difference between the two conditions: MODY can be defined at a molecular level and LADA is hard to define at all. LADA, as discussed in this issue of Diabetologia [1], exists somewhere in the borderland between type 1 and type 2 diabetes, and exemplifies the difficulties we have in telling the two conditions apart. From a historical perspective, it is easy to see how these difficulties arose. Idiopathic diabetes was long considered a single disease, despite mounting evidence of heterogeneity. Once formulated, however, the concept of two major disorders with distinct phenotypes, genetic determinants and aetiology won almost immediate acceptance [2] and now rules our thinking, just as the one-disease concept did in the past. For this reason it is rarely acknowledged that the methods we use are of limited value in telling the two conditions apart [3]. …