LADA: Time for a New Definition

In this issue of Diabetes, Zhou et al. (1) report on theprevalence and characteristics of latent autoimmunediabetes in adults (LADA) in China. Findings fromthis study underscore the profound need for a new definition of LADA. LADA, a slowly progressive form of autoimmune di-abetes that develops in adults and does not require insulin therapy for some time after diagnosis, was first described over 25 years ago (2). Subsequently, clinical, metabolic, immunological, and genetic characteristics that are unique to LADA have been identified (3–6). For example, relative to patients with type 1 diabetes (T1D), those with LADA are more likely to be obese and have other elements of the metabolic syndrome. They are also more likely to retain greater b-cell function, express a single autoantibody (particularly GAD65) and certain GAD65 epitopes (7), and carry the transcription factor 7-like 2 (TCF7L2) gene polymorphism, which is strongly associated with type 2