Therapeutic management of Latent Autoimmune Diabetes in Adults (LADA): systematic review, meta-analysis and future perspectives

• Autor(a) principal: Breda, Inês Casal
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10773/28959
• topic: Autoantibodies; Diabetes mellitus type 1; Diabetes mellitus type 2; Insulin resistance; Interventions; Latent autoimmune diabetes in adults; Treatment; β-cell function

LADA is believed to be a common form of diabetes with characteristics of both type 1 and type 2 diabetes patients. Given the features of the disease, LADA patients are extremely varied in genetic, phenotypic and immunological characteristics encompassing different degrees of insulin resistance and autoimmunity. This diversity might be the result of different pathological mechanisms, which may have implications for treatment and hence a personalized medical method could be needed. This dissertation examines the effects of a series of interventions to improve the treatment approaches to LADA patients and their adverse effects. The objective is to explore the existing treatment interventions on LADA patients and to understand how knowledge can evolve in this field. A total of twenty-two studies including twenty-nine trials were reviewed involving 6562 participants who were followed between three months up to ten years. Combination therapies appear to be a more effective approach to delaying LADA progression. Unfortunately, the heterogeneity in interventions, the criteria related to age range and BMI values, the stratification of outcomes, and the missing of drug(s) wash-out at baseline are not comparable, which make it difficult to generalize and challenging to find consistency in the interpretation, leading to an empty space between what is known and what could be done. The existence of several metabolic and clinical phenotypes in LADA makes it difficult to establish an a priori management intervention to the patients. This points the way towards the need of a personalized medicine approach to a therapy that considers the characteristics and clinical presentation of each patient.