Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 9

9 - Clinical characteristic of 31 patients diagnosed with Latent Autoimmune Diabetes in Adults (LADA) in a Multi-Centric Study in Mexico

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Latent autoimmune diabetes in adults (LADA), is a heterogeneous disease characterized by insulin independence for >6 months after diagnosis and the presence of islet cell autoantibodies. Information regarding LADA epidemiology, patient’s diagnosis, clinical characteristics and follow-up in Mexico is lacking. An online-system, RENACED Diabetes Tipo 1 (DT1), registers longitudinal information of Type 1 Diabetes (T1D) and LADA patients in Mexico.


Methods :

Descriptive analysis of 31 patients  diagnosed with LADA (from 7 different Mexican States) registered in RENACED DT1 as of 10/23/2018.


Results : Sixty-four percent of patients were diagnosed in the last 10 years, 51% women and 49% men. Average diagnosis age was 37 years old (yo). Mean HbA1c and BMI at diagnosis was 9.2% and 24 kg/m2, respectively. Regarding auto-antibody positivity, 61% were positive for GAD65, 9.7% insulin, 6.5% islet, 6.45% IA2, 13% ZnT8 and 19% for ≥2 auto-antibodies.  At diagnosis, 22.5% were hospitalized and 9.7% presented with diabetic ketoacidosis (DKA); 54% were treated with oral agents, 19% with insulin and 9.7% with both.
At the time of analysis, 30 patients remain active (a 61 yo patient died of hepatic carcinoma). Mean age and diabetes duration are 46 yo, and 8 years, respectively. Mean HbA1c and BMI are 8±2% and 24kg/m2, respectively. Initiation of insulin occurred at ≥1 year from diagnosis in 45% of patients. Mean time from diagnosis to insulin use was 687 days ( 0-2191).  Three patients remain off insulin (for 314, 565 and 3144 days). Of the 87% of patients who are on insulin, 12.9% are treated with an insulin pump, 61% are on MDI, 9.7% on basal insulin and 3.2% on a co-formulation; 58% have used metformin, 29% DPP4-inhibitors and 16% sulphonylureas. DKA post diagnosis has occurred in 3 patients, and severe hypoglycemia in 2. One patient has diabetic retinopathy and 3 patients have neuropathy. Hypothyroidism occurs in 22.5% of patients, and 16% are positive for anti-thyroperoxidase antibodies. Dyslipidemia occurs in 22.5% and 2 patients have hypertension.


Discussion :

LADA shares clinical and metabolic characteristics with T1 and T2 diabetes and there is still a high prevalence of misdiagnosed cases. To help understand the presentation of this condition in Mexico, the registration and follow-up of more LADA cases is needed. Interestingly,  in 45% of the patients insulin administration was started at ≥1 year of diagnosis.  


Conclusion :

This is the first report regarding LADA patients in Mexico. Recognizing this condition is important to avoid delay in optimal treatment. Further analysis should study those characteristics associated with delayed insulin use and optimal metabolic control.

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Raquel N. Faradji

MEDICAL DIRECTOR
CLINICA ENDI, Distrito Federal, Mexico

Raquel N. Faradji MD
Education: M.D.– Anahuac University, 1993, Internal Medicine- University of Miami/ Jackson Memorial Hospital, 1996, Endocrinology- Harvard University/ Joslin Diabetes Center, 1999
Affiliations: Medical Director CLINICA ENDI, Director RENACED Diabetes Tipo 1, Staff Centro Medico ABC, Member Sociedad Mexicana de Nutrición y Endocrinología, Mexico.

Carmen Castillo-Galindo

Staff Physician/Diabetes Fellow
Clinica Endi/Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Distrito Federal, Mexico

Internal Medicine/Endocrinology and currently doing an extra year of clinical/research on type 1 diabetes

Natalia E. De la Garza-Hernandez

MD
CEMEDIN

No

Sigfrido MIracle-Lopez

Chief of Endocrinology
Hospital Angeles de las Lomas
Huixquilucan, Distrito Federal, Mexico

Graduated Medical School at Universidad Anahuac in 1995, Graduated Fellowship of Endocrinology at Universidad Nacional Autonoma de Mexico (UNAM) in the Centro Medico Nacional Siglo XXI Medical Center in 2002, Completed a Scholarship at the ASAN Medical Center and the Ulsan University in Seoul, Korea in Radiology im 2014, Completed a Fellowship in Clinical Research at Universidad Anahuac in 2017 and a Masters in Medical Ciences in 2018

Claudia Ramirez-Renteria

Associated investigator
UIM Endocrinologia Experimental CMN Siglo XXI IMSS
Mexico City, Distrito Federal, Mexico

Dr Claudia Ramirez is an endocrinologist graduated from the Unoveridad Nacional autónoma de Mexico. She also holds a degree in masters of science. She has been working as an associates investigator for the Mexican Institute of social security where she collaborates in different lines of investigation including diabetes and Neuroendocrinology.

Alejandro Romero

MD
Hospital Angeles Culiacan, Mexico.
Culiacan, Sinaloa, Mexico

Endocrinologist at Hospital Ángeles Culiacan Mexico

Divany Montes-Valdespino

Nurse Educator
CLINICA ENDI, Distrito Federal, Mexico

Diabetes Educator, Asociación Mexicana de Diabetes (Universidad Anáhuac)- 2017. Nurse Technician - Colegio Nacional de Educación Profesional Técnica, Plantel Coyoacán-2001. Nurse coordinator of Tonalli, Type 1 Diabetes Camp-2016. Coordinator of Diabetes Prevention and Detection Campaigns, DIF.

Maricela Vidrio-Velazquez

Endocrinologist
hospital General Regional 110 IMSS, Jalisco, Mexico

postgraduate Endocrinologist HE CMN La Raza, Master of science Uiversidad de Guadalajara, Profesor postgrade Endocrinologist IMSS

Aurora Rebolledo-Ramirez

Clinical epidemiologist
Centro Nacional para la Prevención yControl del VIH y el SIDA
Ciudad de México, Mexico

Bachelor's degree in Medicine and Master's degree in Public Health and Epidemiology with extensive experience in
epidemiological analysis, supervision and monitoring of clinical trials, health records, management and supervision of
medical research personnel, adherence to ICH and GCP standards and guidelines, preparation and monitoring of SAE
reports and management of relationships with public and private health institutions.

Paloma Almeda-Valdes

Staff Physician
Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran
Mexico City, Distrito Federal, Mexico

MD, with specialty in Internal Medicine and subespecialty in Endocrinology. Masters and PhD in Medical Sciencies. Research interests: diabetes, beta cell function and insulin resistance.

Ana Cecilia Uribe-Wiechers


Colima, Mexico

Jose Juan Ceballos-Macias


Distrito Federal, Mexico