Diagnosed with Type 2 diabetes but feel like treatment isn’t working? You may have been misdiagnosed

Frustration and confusion compelled her to seek a second opinion, unveiling a startling revelation: She had been misdiagnosed. Instead of Type 2 diabetes, Priya was dealing with Latent Autoimmune Diabetes in Adults (LADA), a form of diabetes often misconstrued as Type 2 due to shared symptoms.

Renowned Diabetologist Dr V Mohan, Chairman of the Madras Diabetes Research Foundation, explains that LADA, despite manifesting in adulthood, aligns more closely with the autoimmune nature of Type 1 diabetes. He estimates that approximately 10-15 percent of adults, initially treated for Type 2 diabetes, may actually be grappling with LADA.

“Patients with LADA often experience a slower onset of symptoms and have slower progression than Type 1 diabetes, which occurs in children. LADA is often misdiagnosed as Type 2 diabetes as the symptoms occur by the age of 30-40 years and we start treating it with oral medication, diet, exercise, etc,” Dr Mohan tells South First.

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Misdiagnosing diabetes

There are two types of diabetes that people are typically aware of — Type 1 (typically occurs in children) and Type 2 (typically occurs in adults). LADA, often confused with Type 2 diabetes due to similar symptoms, aligns more with Type 1 as an autoimmune condition.

Dr Mohan notes that patients initially diagnosed with Type 2 diabetes and treated accordingly may show a positive response for about a year.

“However, a sudden increase in blood sugar levels and the development of ketones, along with the need for insulin, become apparent within six months to one year,” he adds.

He emphasises that despite oral medication, these patients fail to respond adequately and it usually takes up to two years for doctors to realise that they are dealing with a different condition.

Characteristics of LADA

Typical characteristics of Latent Autoimmune Diabetes in Adults include patients who:

• are lean
• lack a family history of diabetes
• exhibit no signs of insulin resistance

The C-peptide test, a crucial diagnostic tool, reveals low levels similar to those seen in Type 1 diabetes. When these patients transition to insulin therapy, they respond positively, in contrast to their previous weight loss and poor response to oral medications.

Speaking to South First, Dr Manohar KN, Chairman of the Research Society for the Study of Diabetes in India (Karnataka chapter), mentions the evolving terminology around LADA. While it was called Type 1.5 diabetes — as it shares features of both types — the World Health Organization has proposed “Slowly Evolving Immune-Mediated Diabetes”.

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Problems with misdiagnosis

Complications arise when LADA is misdiagnosed, leading to inappropriate or delayed treatment, say doctors.

Initial treatment with ineffective oral medications can result in poorly controlled blood sugar levels, increasing the risk of long-term complications such as cardiovascular disease, kidney problems, nerve damage, eye problems, and other diabetes-related issues.

When LADA is not accurately diagnosed, the autoimmune attack on pancreatic beta cells can progress rapidly without proper treatment, potentially delaying the initiation of insulin therapy and causing faster beta-cell destruction.

“Patients will start losing weight due to misdiagnosis and have sudden insulin spikes,” Dr Mohan explains.

Also, patients who are treated with medications more suited for Type 2 diabetes, may experience side effects from these drugs without gaining the intended benefits.

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Diagnosing LADA

Dr Mohan underscores that the key to the diagnosis of LADA lies in the presence of GAD antibodies, distinguishing LADA from Type 2 diabetes. This revelation unfolds through a comprehensive blood test.

“This test can check the presence of certain autoantibodies in the blood. The most commonly tested are glutamic acid decarboxylase antibodies (GADA). Other autoantibodies include insulinoma-associated-2 autoantibodies (IA-2A) and zinc transporter 8 autoantibodies (ZnT8A). With this test, the diagnosis can be clinched and type 2 ruled out,” he explains.

Another important test is the C-Peptide test. C-peptide levels help determine how much insulin the body is producing. Low levels of C-peptide, along with high blood glucose levels, may indicate LADA, as the autoimmune attack reduces the body’s ability to produce insulin.

Observation of symptoms is another way to diagnose LADA, says Dr Mohan. Unlike many patients with Type 2 diabetes, individuals with LADA are often not overweight. They may have a normal or lean body type.

“When they are obese, they have dark, velvety patches of skin, primarily on the back of the neck. This condition, known medically as Acanthosis Nigricans, can also manifest in other body parts like the armpits, groin, or arm folds. These patches occur due to high levels of insulin in the skin cells and are commonly found in individuals with Type 2 diabetes or those who are obese,” explains Dr Mohan. People with LADA lack this.

Additionally, LADA patients typically do not show significant insulin resistance, unlike Type 2 diabetes, where insulin resistance is a key feature. This can be assessed through various clinical evaluations.

Lastly, while a family history of autoimmune disease might be present, a family history of Type 2 diabetes is less common in patients with LADA, compared to those with Type 2 diabetes.

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LADA treatment

Once the diagnosis of LADA is confirmed, these patients will have to stop oral medications and start taking insulin, just like patients with Type 1 diabetes. They can be treated with insulin pumps as well, Dr Mohan adds.

In India, where diabetes is already a major public health issue, the misdiagnosis of LADA adds another layer of complexity to the challenge.

Doctors insist that education and awareness among healthcare professionals and patients are crucial in improving the diagnosis and management of LADA. With the right diagnosis and treatment plan, people like Priya can manage their condition more effectively and maintain a better quality of life.