All-cause mortality, cardiovascular and microvascular diseases in latent autoimmune diabetes in adults

Abstract

<p><b>Objective: </b>Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on <a href="">the long-term prognosis of LADA with varying degrees of autoimmunity </a>by comparing it to type 2 diabetes and adult-onset type 1 diabetes.</p><p><b>Study design and methods: </b>This Swedish population-based study included newly diagnosed LADA<b> </b>(n=550, stratified into LADA<sup>low</sup> and LADA<sup>high </sup>by median autoimmunity level), type 2 diabetes (n=2001), adult-onset type 1 diabetes (n=1573), and diabetes-free controls (n=2355) in 2007-2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVD), diabetic retinopathy, nephropathy, and clinical characteristics during follow-up.</p><p><b>Results:</b> Mortality was higher in LADA (hazard ratio [HR]: 1.44; 95% CI: 1.03, 2.02), type 1 (2.31 [1.75, 3.05]) and type 2 diabetes (1.31 [1.03, 1.67]) than in controls. CVD incidence was elevated in LADA<sup>high</sup> (HR 1.67 [1.04, 2.69]) and type 2 diabetes (1.53 [1.17, 2.00]), but not in LADA<sup>low</sup> or type 1 diabetes. Incidence of retinopathy but not nephropathy was higher in LADA (HR 2.25 [1.64, 3.09]) including LADA<sup>high</sup> and LADA<sup>low</sup> than in type 2 diabetes (unavailable in type 1 diabetes). More favorable blood pressure and lipid profiles but higher HbA1c levels were seen in LADA than type 2 diabetes at baseline and throughout follow-up, especially in LADA<sup>high </sup>which resembled type 1 diabetes in this respect.</p><p><b>Conclusion: </b>Despite having fewer metabolic risk factors than type 2 diabetes, LADA has equal to higher risks of death, CVD, and retinopathy. Poorer glycemic control, particularly in LADA<sup>high</sup>, highlights the need for improved LADA management.</p>