Latent autoimmune disease in adults as a cause of diabetes

Around 40 years ago evidence was increasingly coming to light of a cohort of individuals diagnosed with non-insulin dependent diabetes who, despite possessing islet cell autoantibodies, had maintenance of beta-cell function and so – at the time of diagnosis – did not require treatment with insulin.¹

Although these individuals were usually over the age of 35 years and did not present with ketosis (suggesting that they did not have type 1 diabetes), they were typically not obese and lacked the features of metabolic syndrome (as expected in the classical picture of type 2 diabetes).

Furthermore, this group of patients with islet cell autoantibodies – and notably elevated levels of anti-GAD antibody (Box 1) – gradually progressed from treatment of hyperglycaemia with diet and oral hypoglycaemic agents to developing an absolute need for insulin – as expected with type 1 diabetes.²