A Hyperglycemic, Obese and Fast-Weight Losing Adult: A Case Report on Latent Autoimmune Diabetes with Low Anti-Gad65 Titers

Abstract

Introduction: Latent Autoimmune Diabetes in Adults (LADA) is an autoimmune endocrine disorder, in which in spite of having positive anti-islet antibodies, the progression to full blown beta cell destruction and insulin insufficiency is slower. This scenario is often mistaken by other types of diabetes and due to this misdiagnosis the initial treatment is often mistaken. Clinical case: Male subject, 26 years of age, obese at the moment of the first hyperglycemic crisis, with a previous diagnosis of Type 2 Diabetes Mellitus (T2DM) 3 years before arriving to our institution. He refers to have been on oral treatment for his disease with no metabolic control, finally succumbing to polyuria, polydypsia and an important weight loss of 30 kg in the course of 1 year. Family history shows first and second degree history of T2DM. Upon arrival, physical examination showed 140/85 mmHg, BMI 30.31 kg/m 2 , fasting glycemia 283.90 mg/dL, postpandrial glycemia 306.70 mg/dL, fasting C- peptide 2.0 ng/mL, postprandial C-peptide 3.4 ng/mL, HOMAbcell 12.7%, HOMA2-IR 1.8. A presumptive diagnosis of LADA was made and confirmation was obtained with positive anti-GAD65 titers. Intense insulin therapy was initiated and the patient evolved adequately. Conclusions: LADA should be suspected in patients whose metabolic parameters decline continuously and severely, even in those who are keeping up with the oral antidiabetics. In this patient, the age of onset, family history of T2DM, unattainable metabolic control, and steep weight loss were important signs in the proper reclassification and aid in the initiation of proper medical treatment.