**7. Complications**

The frequency of ketoacidosis has not been documented in LADA, but it is assumed to be very low. Chronic vascular complications associated with type 1 diabetes and type 2 diabetes are also present in LADA [55].

#### **7.1. Chronic complications**

Few studies have addressed this issue. Cabrera-Rode et al. describe a lower incidence of retinopathy, nephropathy and peripheral vascular disease, in comparison with type 2 diabetics, although without significant differences given the small number of patients. Recently, a study in Korea, with more than 300 patients (5.3% classified as LADA, 70% in insulin therapy), reveals that the risk of developing microvascular complications is similar to diabetic patients type 1 and 2 [55, 56].

higher level than in patients with type 2 diabetes and could be related to the lower prevalence

Latent Autoimmune Diabetes in Adults http://dx.doi.org/10.5772/intechopen.72685 31

Different studies show that insulin therapy is the ideal treatment to achieve a better metabolic

This procedure is useful to reduce the destruction of β-cells when there is a break in their activity, which determines a decrease in the expression of pancreatic antigens in β-cells [3, 61–68]. The application of an early insulin treatment in subjects with LADA who present a discrete insulin secretion is beneficial, and influences the preservation of pancreatic β-cell function. The early and correct identification of the LADA is necessary to define the adequate therapeu-

In patients initially diagnosed as type 2 diabetic, a number of therapeutic options are possible

It is at this moment where conjecturing or establishing a therapeutic goal is a challenge; because alternatives have been sought for the management of our patients, among which are

Beside diet, sulfonylureas are largely used in patients with type 2 diabetes. Sulfonylureas stimulate insulin secretion by promoting closure of the ATP-dependent potassium channels

They are effective as blood glucose reducers, however, there is experimental evidence that they can increase the immune response, so they are considered imprudent, as they could

In 1996, Kobayashi and 114 others observed that the administration of small doses of insulin was an effective treatment in individuals with recently diagnosed LADA, which is expressed by a high rate of negative conversion of the AHF and an increase in the levels of C-peptide. In serum, on the other hand, when a sulfonylurea (glibenclamide) is used alone in these diabetics, the persistence of the ICA is maintained and there is a progressive decrease in the levels

Treatment with metformin has no direct action on the β cell, and it could be indicated in patients with LADA with clinical characteristics of metabolic syndrome or with obesity. This treatment allowed a good control of HbA1c and caused a drastic decrease in insulinemia [69]. In these cases, a combination therapy of metformin with insulin could also be considered.

Nevertheless, one potential problem associated with the use of metformin is the development

of lactic acidosis in a patient at high risk of becoming insulin-dependent.

of the metabolic syndrome in the first ones [60].

tic behavior and improve the prognosis of these individuals.

that coincide with present available treatments of hyperglycemia.

accelerate the progression towards insulin dependence [3, 22].

control in subjects with type LADA DM.

mentioned.

**8.1. Sulfonylureas**

on pancreatic b-cells.

of C-peptide in the serum.

**8.2. Biguanides**

#### **7.2. Diabetes microvascular and macrovascular complications**

It has been observed that the prevalence of microvascular complications in LADA is broadly similar to that observed in patients with type 2 diabetes, however in a small study conducted by Myhill et al., reported a lower risk of nephropathy [51, 55–57].

It is important to mention that patients with LADA generally have a more favorable cardiovascular risk profile than those with type 2 diabetes. However, to date, different studies have found no evidence of a lower risk of macrovascular disease in patients with DM type LADA [51, 55, 57].

The independent associations of hypertension, hyperlipidemia, obesity and hyperglycemia with macrovascular disease in diabetic patients are well established. Interestingly, hypertension, hyperlipidemia and obesity were less frequent in LADA than in type 2 diabetes [55], but the rates of macrovascular complications were similar. Possible explanations include differences in pathogenesis or treatment.

Given the autoimmune pathology, patients with LADA may have greater systemic inflammation, involved in vascular pathology [58].

It is a fact that patients with LADA can be treated suboptimally because they often start treatment with insulin later than clinically indicated, due to unrecognized insulin deficiency, detection of specific antibodies and a reluctance to change oral therapies to injections.

They are also likely to have a shorter duration of treatment with metformin, an oral agent associated with a lower rate of ischemic heart disease in the UKPDS [59].

Although these studies were small, there is no evidence to support a less aggressive treatment policy for cardiovascular risk factors in patients with LADA.
