Management of Latent Autoimmune Diabetes of Adults (LADA) or Type 1 Diabetes in Adults

Diagnosis and Clinical Presentation

The combination of thin body habitus, history of gestational diabetes, and failure of oral agents strongly suggests latent autoimmune diabetes of adults (LADA) or type 1 diabetes rather than type 2 diabetes, and should be transitioned to insulin therapy immediately while checking C-peptide and GAD antibodies to confirm the diagnosis, as recommended by the American Diabetes Association 1, 2
Women with a history of gestational diabetes who later develop diabetes in their 60s while remaining thin likely had underlying autoimmune beta-cell destruction that was unmasked during pregnancy, according to the American College of Obstetricians and Gynecologists 1

Insulin is the preferred and necessary treatment for this patient, as stated by the American Diabetes Association 3, 2, 4, 1
Start basal insulin (such as insulin detemir or glargine) at 0.1-0.2 units/kg/day, as recommended by the Endocrine Society 3

Order C-peptide level (fasting or random) - will be low/undetectable in insulin deficiency, as indicated by the American Association of Clinical Endocrinologists 3
Order GAD antibodies (glutamic acid decarboxylase) - positive in LADA/type 1 diabetes, according to the American Diabetes Association 1
Order IA-2 antibodies - additional autoimmune marker, as recommended by the European Association for the Study of Diabetes 3
Order Hemoglobin A1C - assess overall glycemic control, as stated by the International Diabetes Federation 1

Aim for fasting blood glucose: 80-130 mg/dL, as recommended by the American Diabetes Association 2
Aim for postprandial (2 hours after meals) blood glucose: <180 mg/dL, according to the European Association for the Study of Diabetes 2
Aim for A1C goal: <7% (or <6.5% if achievable without hypoglycemia), as stated by the American College of Endocrinology 1

Multiple daily injections (basal-bolus regimen) or insulin pump therapy may be needed, as recommended by the International Diabetes Federation 4
Carbohydrate counting education, as stated by the Academy of Nutrition and Dietetics 3
Continuous glucose monitoring may be beneficial for optimizing control, according to the American Association of Clinical Endocrinologists 3
Endocrinology referral for specialized diabetes management, as recommended by the Endocrine Society 2