SAT-602 Geriatric LADA: A Need for Close Clinical Monitoring in Diabetes Patients

Abstract Disclosure: A. Khorochkov: None. M.A. Calle Prado: None. A.D. Ardeljan: None. C. Fretter: None. P.L. Sareh: None. latent autoimmune diabetes of adult (LADA) is a form of autoimmune diabetes similar to type 1 diabetes mellitus (T1DM), but defined by later onset between ages 30 to 50, as well as positive autoantibodies to islet ß cells, and an insulin non-dependence for 6 months after the initial diagnosis. However, new-onset autoimmune conditions are uncommon in the elderly age group. A 74-year-old female with a past medical history of hypothyroidism secondary to Hashimoto’s thyroiditis on levothyroxine, vitiligo, and osteoporosis was found to have an HbA1c of 11.1% on routine labs, when only 14 months prior she was in the prediabetic range with HbA1c 5.8%. Initially, she was started on empagliflozin, 10 units of glargine, and a continuous glucose monitor. Her blood glucose ranged between 70-180 mg/dL, including pre- and postprandial insulin measurements, with some values dipping below 60 mg/dL. Glargine was incrementally decreased to 8 units, then 6 units, and empagliflozin was discontinued, due to the frequency of hypoglycemic episodes. C-peptide was obtained to assess ß cell function and found to be low at 0.8 nmol/L. Given the rather rapid increase in HbA1c, history of autoimmune diseases, as well as low C-peptide, insulin autoantibodies were ordered. She was found to have negative anti-insulin antibodies, but positive anti-GAD 65, IA-2, ZNT8 antibodies, indicating new onset LADA. With adherence to her insulin regime and diet plan, her A1c improved to 6.4%. The immune destruction of ß islet cells in LADA is much slower than in classic T1DM, and as a result patients may not require insulin initially, leading to potential misdiagnosis as type 2 diabetes mellitus (T2DM). Treatment of T2DM is initiated with oral antihyperglycemic agents; however, as seen in in this case, the pathophysiology stems from a reduction in insulin synthesis instead of insulin resistance, thereby, rendering oral antihyperglycemics subtherapeutic in LADA. Proposed management is focused on metabolic control with preservation of ß cell function. Screening for GAD antigens has a role in all newly diagnosed T2DM due to its high sensitivity followed by C-peptide level monitoring. Although there are no standard guidelines for management, a proposed algorithm suggests use of insulin therapy in cases with C-peptide <0.3 nmol/L and reassessment every 6 months. We describe a case of LADA in an elderly patient, presenting outside of the expected demographic. Although uncommon, LADA can develop in geriatric populations; a thorough history, especially of autoimmune diseases, and clinical monitoring is necessary to discern LADA from mimicry of T2DM. Presentation: Saturday, July 12, 2025