Latent autoimmune diabetes in adults (LADA)
Written by Sarah Linklater, PhD with clinical review by Cathy J. Sun, MD, MSc, FRCPC (Endocrinology)
What is LADA?
Latent autoimmune diabetes in adults (LADA), also known as type 1.5 diabetes, is a form of type 1 diabetes (T1D) that has features of both T1D and type 2 diabetes (T2D). LADA is estimated to account for approximately 10% of adult diagnoses of all diabetes. A commonly used definition for LADA is from the Immunology of Diabetes Society, which has the following diagnostic criteria1,2,3,4:
- Adult-onset of diabetes (>30 years of age)
- Diabetes associated autoantibodies present (primarily GADA, less frequently IAA, IA-2A or ZnT8A)
- Insulin not required for at least 6-months after diabetes diagnosis*
*Since the decision to start insulin is clinician-dependent and initial diagnosis is often delayed, this criterion can be hard to confirm.
LADA has been the subject of debate in the field: some consider that it is a distinct subtype of diabetes; others consider that it is simply a slower-progressing form of T1D. Regardless, having a correct diagnosis and developing a personalized care plan with your health care team is important to live well with LADA.
The autoimmune process in LADA happens more slowly than in typical T1D, which is why insulin therapy is not needed right away at diagnosis. LADA is also a heterogeneous disease. Therefore, there is substantial variability in when each person living with LADA progresses to requiring insulin therapy. Importantly, since levels of hyperglycemia (high blood glucose) are generally lower at diagnosis than typical T1D, LADA is often misdiagnosed and managed as T2D. When changes advised to treat T2D — such as diet, exercise, or medications like metformin — don’t result in the anticipated effect in lowering blood glucose, it can not only be frustrating and result in less satisfactory health outcomes, but can also cause feelings of guilt, shame and failure for not being able to ‘properly manage’ their diabetes.
Read Jim Beatty’s story
How is LADA treated?
In line with the fact that LADA has features of both T1D and T2D, most people with this diagnosis will typically follow a modified T1D care plan, which may include:
- Glucose-lowering drugs frequently used for T2D that help to control glucose and protect remaining insulin-producing (beta) cells;
- Diet and lifestyle modifications similar to those recommended in people with T2D, particularly in people with LADA who are also managing insulin resistance or obesity, or with physical inactivity or a history of smoking; and/or
- Insulin therapy, if the above treatments don’t bring blood glucose to within target ranges.
Please note that these are general guidelines and individual care plans should be developed with a healthcare provider.
Living well with LADA
A diagnosis of LADA should be approached similarly to T1D. It is important to develop a personalized health care plan together with your diabetes care team that aims to optimize time in range, limits hyper and hypoglycemic episodes, lowers the risk of diabetic ketoacidosis (DKA) and other diabetes-related complications, along with consideration of the psychosocial impact of managing a chronic disease.
Speak with your healthcare provider about what diabetes technologies, like advanced glucose monitors, insulin pumps or automated insulin delivery systems may work best for you, along with the type of insulin that matches best once insulin therapy is required. As people living with LADA may still be producing insulin at the time of diagnosis, the aim at that time is to try and preserve the remaining insulin-producing cells as long as possible, and to help the person better understand their diabetes, carb counting and monitoring blood glucose before beginning insulin therapy.
Being diagnosed with LADA may mean completely changing your lifestyle and including family members and potentially employers and colleagues in the new normal that you must establish. It may also bring emotional and mental health challenges, because diabetes can be a difficult and demanding condition. Daily management, dealing with emergencies, fear of complications and other health issues, and modifications to treatment, can be overwhelming at times. There can also be a stigma associated with this disease that is often invisible to others. This can lead to diabetes distress, defined as a range of emotional responses to living with and managing diabetes. Diabetes distress can include feeling overwhelmed with the burden of managing diabetes; fear and worries about complications or experiencing a severe low blood glucose; and feeling defeated, discouraged, or burned out when you are not meeting your blood glucose goals despite your best efforts to manage them.
Recognizing these signs and when to get professional support is crucial, as is learning how to advocate for yourself with your healthcare providers.
Breakthrough T1D Canada has resources and support programs that can help.
To find more information on navigating an adult diagnosis with your workplace.
To find a mental healthcare provider specifically trained in diabetes: please visit the Mental Health + Diabetes Directory.
For more information on mental health supports, please see our mental health resources page.
T1D community resources & events
Web resources and blogs:
References:
- Fourlanos S, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005 Nov;48(11):2206-12. doi: 10.1007/s00125-005-1960-7.
- Buzzetti R, et al. Management of latent autoimmune diabetes in adults: a consensus statement from an international expert panel. Diabetes. 2020 Oct;69(10):2037-2047. doi: 10.2337/dbi20-0017.\
- Jones AG, et al. Latent autoimmune diabetes of adults (LADA) is likely to represent a mixed population of autoimmune (type 1) and nonautoimmune (type 2) diabetes. Diabetes Care. 2021 Jun;44(6):1243-1251. doi: 10.2337/dc20-2834.
- Rajkumar V and Levine SN. Latent autoimmune diabetes. [Updated 2024 Mar 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557897/
How to get support
Breakthrough T1D Canada has several resources to help navigate a new T1D diagnosis, as well as programs to make personal connections with those who share similar experiences.
Breakthrough T1D peer support
We offer many different types of support, so you can find the one that works best for you.
Breakthrough T1D Connection series:
A national virtual meetup for adults and parents in the T1D community on the 4th Wednesday of each month. We host a virtual meetup for both adults living with T1D, and parents living with or affected by T1D. Grow relationships with your peers who may share similar life experiences or treatment types and understand the ever-changing demands of T1D.
Breakthrough T1D Type 1 Diabetes Facebook Support Group
A moderated group that provides a safe space for the T1D community to connect with others affected by the disease. We have trained Breakthrough T1D peer support volunteers to moderate and answer non-medical questions as needed. We know that peer support is important throughout many life changes.
Adult Care Kit
The Breakthrough T1D Adult Care Kit is a free resource for those 18+ and provides information and tools to help support adults newly diagnosed with T1D. To request an adult care kit: