American Diabetes Association
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All-cause mortality, cardiovascular and microvascular diseases in latent autoimmune diabetes in adults

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posted on 2023-08-28, 00:10 authored by Yuxia Wei, Katharina Herzog, Emma Ahlqvist, Tomas Andersson, Thomas Nyström, Yiqiang Zhan, Tiinamaija Tuomi, Sofia Carlsson

Objective: Latent autoimmune diabetes in adults (LADA) is a heterogenous, slowly progressing autoimmune diabetes. We aim to contribute new knowledge on the long-term prognosis of LADA with varying degrees of autoimmunity by comparing it to type 2 diabetes and adult-onset type 1 diabetes.

Study design and methods: This Swedish population-based study included newly diagnosed LADA (n=550, stratified into LADAlow and LADAhigh by median autoimmunity level), type 2 diabetes (n=2001), adult-onset type 1 diabetes (n=1573), and diabetes-free controls (n=2355) in 2007-2019. Register linkages provided information on all-cause mortality, cardiovascular diseases (CVD), diabetic retinopathy, nephropathy, and clinical characteristics during follow-up.

Results: Mortality was higher in LADA (hazard ratio [HR]: 1.44; 95% CI: 1.03, 2.02), type 1 (2.31 [1.75, 3.05]) and type 2 diabetes (1.31 [1.03, 1.67]) than in controls. CVD incidence was elevated in LADAhigh (HR 1.67 [1.04, 2.69]) and type 2 diabetes (1.53 [1.17, 2.00]), but not in LADAlow or type 1 diabetes. Incidence of retinopathy but not nephropathy was higher in LADA (HR 2.25 [1.64, 3.09]) including LADAhigh and LADAlow than in type 2 diabetes (unavailable in type 1 diabetes). More favorable blood pressure and lipid profiles but higher HbA1c levels were seen in LADA than type 2 diabetes at baseline and throughout follow-up, especially in LADAhigh which resembled type 1 diabetes in this respect.

Conclusion: Despite having fewer metabolic risk factors than type 2 diabetes, LADA has equal to higher risks of death, CVD, and retinopathy. Poorer glycemic control, particularly in LADAhigh, highlights the need for improved LADA management.


The ESTRID study was supported by the Swedish Research Council (2018-03035), Research Council for Health, Working Life and Welfare (FORTE, 2018-00337). The ANDIS study was financed by Swedish governmental funding of clinical research (ALF), the Swedish Research Council project grant nos. 2020-02191, 2015-2558, infrastructure grant nos. 2010-5983, 2012-5538, 2014-6395, Linnaeus grant no. 349-2006-237, and strategic research grant nos. 2009-1039 (EXODIAB) and IRC15-0067 (LUDC-IRC)). YW received a scholarship from the China Scholarship Council (student number 202006010041). The sponsors had no role in the study design, data collection, data analysis and interpretation, writing of the report, or the decision to submit the article for publication.


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