Clinical Approach to Latent Autoimmune Diabetes in Adults: State of the Art and Future Perspectives

Latent autoimmune diabetes in adults (LADA) is the most common form of type 1 diabetes (T1D) that appears in adulthood. Initially, its clinical presentation resembles type 2 diabetes (T2D). Consequently, some cases are misdiagnosed as T2D and treated accordingly. The LADA phenotype is observed in nearly 10% of adult patients with newly diagnosed T2D. However, because of gradual β-cell destruction, the presence of islet autoantibodies, and the need for insulin within 6 months to several years of diagnosis, LADA is considered a distinct T1D phenotype. Therefore, LADA has broadened the concept of autoimmune diabetes. Despite extensive research, LADA remains underrecognized by clinicians. Currently, there is no global consensus on the classification, diagnosis, or treatment of LADA. The clinical course varies significantly by age at onset, genetic background, and underlying immune mechanisms. Furthermore, the presence of other autoimmune diseases, particularly Hashimoto’s thyroiditis, increases the risk of LADA. Non-insulin antidiabetic medications (excluding insulin secretagogues) can be used as initial therapy in patients with sufficient pancreatic β-cell reserve. However, when endogenous insulin reserves are depleted, initiating insulin therapy is critical to reduce the risk of acute metabolic decompensation and long-term complications. New immunotherapeutic approaches aimed at preserving the remaining β-cells in patients with LADA are being developed. This review examines the terminology, genetics, pathology, diagnostic criteria, and management of LADA, based on current knowledge and recent research. It also aims to discuss novel approaches and future perspectives in this field.

Cite this article as: Satman I. Clinical approach to latent autoimmune diabetes in adults: state of the art and future perspectives. Endocrinol Res Pract. Published online September 1, 2026. doi: 10.5152/erp.2026.261032.