Latent Autoimmune Diabetes in the Adults (LADA): A Unique Heterogeneous Clinical Entity or Just an Enigma?

Autoimmune diabetes in adults reflects a broad clinical phenotype ranging from keto acidosis to mild non insulin requiring diabetes with preserved beta cell function. The former is typical of type 1 diabetes mellitus while the latter usually takes an insidious course mimicking type 2 diabetes mellitus. However,younger age at onset and the presence of circulating antibodies, albeit to a lesser extent than type 1 diabetes, distinguishes it from type 2 diabetes.Thus it needed to be labelled as a separate entity and researchers termed it as Latent Autoimmune Diabetes in the Adults(LADA). Its definition, pathogenesis and nomenclature has been questioned repeatedly rendering it a very controversial topic in diabetes.Prospective studies have established that beta cell failure can be there as early as within 5 years in cases of high antibody titre. Moreover,there is marked diminution of beta cell response to intravenous glucagon and glucose in patients of LADA. Consequently, LADAis not always a latent disease. This review is to summarize the discrepancies concerning this topic and the scope of a better justifiable terminology as ‘Autoimmune Diabetes in adults with slowly progressive beta cell failure’ in place of LADA. It also focuses on revision of the existing diagnostic criteria to capture the pathogenesis and thereby set therapeutic targets.