G571(P) Should the diagnosis of ‘latent autoimmune diabetes in youth’ be considered for paediatric patients? a case report

Abstract

Aims To highlight that Latent Autoimmune Diabetes in Adults (LADA) may occur in a broader age group than currently defined and therefore may affect the paediatric population. To improve clinician awareness of the chance of progression from clinically type 2 features to type 1 (as described in adult LADA cases) in the presence of any autoantibodies, which will ensure adequate monitoring, patient counselling, and early initiation of insulin when needed. Background Making a clear distinction in the diagnosis of diabetes is important to ensure that appropriate treatment and counselling for future management is given. The use of immunological and genetic investigations can help aid with diagnosis. Case We report a paediatric case who presented with classically type 2 features but with a single weakly positive GAD autoantibody, and whose symptoms and glucose levels resolved with weight reduction. 20 months later she had begun to display symptoms more suggestive of Type 1 diabetes together with 3 positive autoantibodies, therefore insulin treatment was started. A description of non-insulin dependent adult patients with positive autoantibodies has been referred to as ‘latent autoimmune diabetes of adults’ (LADA), who have high likelihood of early progression to insulin requirement, but diagnostic criteria includes patient age of more than 30 years.1 Conclusion This case supports the proposal that a latent autoimmune diabetes picture does also present in the youth population. It is our opinion that for patients who have clinical features suggesting type 2 diabetes, with any positive autoantibodies, clinicians should be alert to a greater risk of developing Beta cell destruction and an early insulin requirement. Patients should be counselled to this risk and monitoring frequency planned accordingly. Positive auto-antibodies also indicate the need to monitor for associated auto-immune conditions, as advised in ISPAD guidelines, which is not otherwise routinely indicated in antibody negative type 2 diabetes. Reference Ramachandra G, Naik Barbara M, Brooks-Worrell Jerry P. Palmer. (2009) Latent Autoimmune Diabetes in Adults. The Journal of Clinical Endocrinology & Metabolism 2009;94:4635–4644.