Diabetes classification: grey zones, sound and smoke: Action LADA 1

Diabetes/Metabolism Research and Reviews2008Vol. 24(7), pp. 511–519

Citations Over TimeTop 10% of 2008 papers

Richard David Leslie, Hubert Kolb, Nanette C. Schloot, Raffaella Buzzetti, Dı́dac Mauricio, Alberto de Leiva, Knud Bonnet Yderstræde, Cristina Sarti, Charles Thivolet, David R. Hadden, Steven Hunter, Guntram Schernthaner, Werner A. Scherbaum, Rhys Williams, Paolo Pozzilli

Abstract

Diseases gain identity from clinical phenotype as well as genetic and environmental aetiology. The definition of type 1 diabetes is clinically exclusive, comprising patients who are considered insulin dependent at diagnosis, whilst the definition of type 2 diabetes is inclusive, only excluding those who are initially insulin dependent. Ketosis-prone diabetes (KPD) and latent autoimmune diabetes in adults (LADA) are each exclusive forms of diabetes which are, at least initially, clinically distinct from type 2 diabetes and type 1 diabetes, and each have a different natural history from these major types of diabetes.KPD can be diagnosed unequivocally as diabetes presenting with the categorical clinical feature, ketoacidosis. In contrast, LADA can be diagnosed by the co-occurrence of three traits, not one of which is categorical or exclusive to the condition: adult-onset non-insulin-requiring diabetes, an islet autoantibody such as glutamic acid decarboxylase autoantibodies (GADA) or cytoplasmic islet cell autoantibodies (ICA), and no need for insulin treatment for several months post-diagnosis. But while some would split diabetes into distinct subtypes, there is a strong case that these subtypes form a continuum of varying severity of immune and metabolic dysfunction modified by genetic and non-genetic factors. This article discusses the nature of disease classification in general, and KPD and LADA in particular, emphasizing the potential value and pitfalls in classifying diabetes and suggesting a need for more research in this area.

Citations Over TimeTop 10% of 2008 papers

Abstract

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