by Marco Comoglio
Phase 3 studies showed that dulaglutide reduces glycated hemoglobin levels and increases markers of beta-cell function in patients
I suffer from “Lada” type diabetes and I have heard about new drugs, for example in the form of a weekly injection. Are they also suitable for my type of diabetes?
Marco Comoglio, diabetologist, Association of Diabetologists (GO TO THE FORUM) responds
«Lada» diabetes (latent autoimmune diabetes of adults) is a slowly progressive autoimmune form which, in Italy, affects approximately 5% of adults with a previous diagnosis of type 2 diabetes mellitus. Lada begins in adulthood (> 30 years) with a deterioration of beta-cell function, a consequence of progressive damage to the pancreas induced by autoantibodies. Since the progression of the damage is slow, it does not initially require insulin treatment (within 6 months of diagnosis), unlike type 1 diabetes mellitus which requires insulin therapy immediately. Lada is frequently not recognized because, appearing in adulthood, it is mistaken for type 2 diabetes.
Exams
The diagnosis is made by determining the presence of autoantibodies – GADA (anti-glutamic acid decarboxylase antibodies), IA-2A (anti-tyrosine phosphatase antibodies), ZnT8A (anti-zinc transporter 8 antibodies) and IAA (anti-zinc transporter 8 antibodies). -insulin) – and the evaluation of beta-cell functionality, by measuring basal and post-stimulus C-peptide. The positivity of even just one of the antibodies listed allows the diagnosis of Lada to be made, while the evaluation of beta-cell function allows the degree of progression of the damage of the disease to be assessed. As in all forms of diabetes, the first step in therapy is a correct lifestyle with aerobic physical activity and a Mediterranean diet, with a limitation of simple sugars.
Drugs
The drug therapy of choice, when necessary, is insulin, even at low doses. The new drugs (DPP IV and GLP1-RA) have proven effective and SGLT2i could also be a good therapeutic option, but to date there are few studies on the use of these drugs in Lada. In particular, regarding dulaglutide (weekly injection), phase 3 studies (AWARD-2, -4 and -5) were evaluated: they showed that dulaglutide significantly reduced HbA1c (glycated hemoglobin) levels and increased marker of beta-cell function in Lada patients. However, large-scale studies, with long-term follow-up, are needed to confirm the efficacy of GLP1-RAs in preserving metabolic control and delaying progression to insulin dependence in Lada type diabetes.
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January 25, 2024 (modified January 25, 2024 | 11:16)
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