Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype
Open accessAbstract
OBJECTIVE: Specific autoantibodies characterize type 1 diabetes in childhood but are also found in adult-onset diabetes, even when initially non–insulin requiring, e.g., with latent autoimmune diabetes (LADA). We aimed to characterize adult-onset autoimmune diabetes. RESEARCH DESIGN AND METHODS: We consecutively studied 6,156 European diabetic patients attending clinics within 5 years of diagnosis (age range, 30–70 years) examined cross-sectionally clinically and for GAD antibodies (GADA) and antibodies to insulinoma-associated antigen-2 (IA-2A) and zinc-transporter 8 (ZnT8A). RESULTS: Of 6,156 patients, 541 (8.8%) had GADA and only 57 (0.9%) IA-2A or ZnT8A alone. More autoantibody-positive than autoantibody-negative patients were younger, leaner, on insulin (49.5 vs. 13.2%), and female (P < 0.0001 for each), though LADA patients (9.7% of total) did not show categorically distinct clinical features from autoantibody-negative type 2 diabetes. Similarly, more GADA patients with high (>200 World Health Organization IU) (n = 403) compared with low (n = 138) titer were female, lean, and insulin treated (54.6 vs. 39.7%) (P < 0.02 for each). Autoantibody-positive patients usually had GADA (541 of 598; 90.5%) and had LADA more often than type 1 autoimmune diabetes (odds ratio 3.3). CONCLUSIONS: Adult-onset autoimmune diabetes emerges as a prevalent form of autoimmune diabetes. Our results indicate that adult-onset autoimmune diabetes in Europe encompasses type 1 diabetes and LADA in the same broad clinical and autoantibody-positive spectrum. At diagnosis, patients with adult-onset autoimmune diabetes are usually non–insulin requiring and clinically indistinguishable from patients with type 2 diabetes, though they tend to be younger and leaner. Only with screening for autoantibodies, especially GADA, can they be identified with certainty.
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Latent autoimmune diabetes in adults is the most common form of autoimmune diabetes mellitus diagnosed in adults, with a prevalence in Europe, China and the United Arab Emirates between 3 and 12 times higher than that of adult-onset type 1 diabetes mellitus.
“LADA is the most common form of autoimmune diabetes mellitus diagnosed in adults, with a prevalence in Europe, China and the United Arab Emirates between 3 and 12 times higher than that of adult-onset T1DM77–79.”
From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [77]
The Results section (page unavailable) reports that LADA was more prevalent than classic adult-onset autoimmune type 1 diabetes in the European cohort, with an odds ratio of 3.3. The paper does not establish the claimed comparison for China or the United Arab Emirates, or a 12-fold difference. (LLM, conf=0.89)
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- Authors
- Hawa, M. I., Kolb, H., Schloot, N., Beyan, H., Paschou, S. A., Buzzetti, R., Mauricio, D., De Leiva, A., Yderstraede, K., Beck-Neilsen, H., Tuomilehto, J., Sarti, C., Thivolet, C., Hadden, D., Hunter, S., Schernthaner, G., Scherbaum, W. A., Williams, R., Brophy, S., Pozzilli, P., Leslie, R. D., & on behalf of the Action LADA consortium
- Affiliations
- Queen Mary University of London (GB)
- Heinrich Heine University Düsseldorf (DE)
- Blizard Institute, Queen Mary University of London, London, U.K.
- Sapienza University of Rome (IT)
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN)
- Odense University Hospital, Odense, Denmark
- Odense University Hospital (DK)
- Finnish Institute for Health and Welfare (FI)
- Hôpital Edouard Herriot (FR)
- Royal Victoria Hospital (GB)
- Krankenanstalt Rudolfstiftung der Stadt Wien (AT)
- Swansea University (GB)
- Università Campus Bio-Medico (IT)
- Corresponding author
- Leslie, Richard David
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2013-03-14
- Volume
- 36
- Issue
- 4
- Pages
- 908-913
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3609504
- OpenAlex
- W1969080742
- Cited by
- 339
- References
- 24
- Citations by year
- 2026: 25 · 2025: 22 · 2024: 19 · 2023: 15 · 2022: 33 · 2021: 22 · 2020: 23 · 2019: 29 · 2018: 31 · 2017: 30 · 2016: 23 · 2015: 25 · 2014: 25 · 2013: 16 · 2012: 1
- FWCI
- 12.87
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- latent autoimmune diabetes in adults, type 1 diabetes, glutamic acid decarboxylase antibodies, IA-2 autoantibodies, autoantibody detection, clinical phenotype, type 2 diabetes misdiagnosis, insulin requirement, antibody titers
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