L'Analisi della composizione corporea rivela l'esistenza di un'intrinseca eterogeneità clinica nel diabete latente autoimmune dell'adulto (LADA)

Background and aim: Latent autoimmune diabetes in adults (LADA) is characterized by the presence of islet autoantibodies in adult (over 35 years) patients with the phenotype of type 2 diabetes (T2D) at diagnosis, and not requiring insulin for at least 6 months after diagnosis. Although a low BMI was reported to be associated with a faster progression of the disease, the body composition in LADA is scarcely known. In this study the body composition of a large (n=251) LADA cohort was thoroughly investigated. Methods: We determined the body composition in 251 LADA patients, 251 T2D patients and 135 late-onset type 1 diabetes (T1D) patients of Sardinian origin. Weight, height, fat mass and lean mass were evaluated in a sample of patients using anthropometry, electric bioimpedance analysis (EBIA) and Dual Energy X-rays Absorption (DXA). Results: in LADA patients BMI shows a clear bimodal distribution with peaks at 28 and 33 kg/m², whereas in late-onset T1D and T2D the distribution is strictly unimodal. Visceral fat, but not total fat amount, is significantly lower in LADA compared to T2D. BMI-adjusted resting energy expenditure (REE) is also significantly increased in LADA compared to T2D. Conclusion: The bimodal distribution of BMI in LADA suggests the existence of two subgroups of patients with different body composition and fat distribution, and further underline the clinical heterogeneity of this subtype of diabetes.