Increased Glycation Ratio and Risk of Complications in Latent Autoimmune Diabetes in Adults Compared With Type 1 Diabetes Onset before 30 Years: A Cohort Study

Objective: To clarify the distinctions between Latent Autoimmune Diabetes in Adults (LADA) and Type 1 diabetes (T1D) diagnosed < 30 years using continuous glucose monitoring (CGM) metrics, glycation rate, and risk of complications. Design and Methods: Multicenter, cross-sectional, observational study including subjects with T1D onset < 30 years (T1D cohort) and those classified as LADA diagnosed ≥ 30 years (LADA cohort) with ≥ 80% CGM coverage 56 days prior to glycated hemoglobin (HbA1c). Logistic regression was used to model the risk of complications. Results: T1D ( n = 555) and LADA ( n = 890) showed different ages (43 vs. 58 years; P < 0.001), age at diagnosis (16 vs. 43 years; P < 0.001), diabetes duration (26.8 vs. 15.1 years; P < 0.001), HbA1c (7.2 vs. 7.3%; P = 0.017), microvascular complications (35 vs. 23%; P < 0.001), and daily total and basal insulin [0.63 vs. 0.59 U/(kg·d); P = 0.006 and 0.35 vs. 0.32 U/(kg·d); P = 0.002]. After adjusting for diabetes duration, T1D exhibited higher time below range (TBR70: 3.9 vs. 3.0%; P < 0.001; TBR54: 0.5 vs. 0.3%; P < 0.001) and variability [coefficient of variation (CV): 35.6 vs. 34.2%; P < 0.001; within-day CV: 31.4 vs. 30.3%; P < 0.001]. Personal glycation ratio was higher in LADA after adjusting for diabetes duration and body mass index (66.5 vs. 64.9%; P < 0.001). Estimated risks of macrovascular and microvascular complications were higher in LADA than in T1D [12.6% (95% CI 9.7–15) vs. 3.8% (95% CI 2.1–5.6) and 46.1% (95% CI 40.4–52.0) vs. 29.1% (95% CI 25.1–33.5)] after adjusted for diabetes duration. Conclusions: LADA cohort showed a higher glycation rate and lower time in hypoglycemia and variability. Microvascular complications were more common in T1D, but after adjusting for diabetes duration, macrovascular and microvascular risks were greater in LADA.

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Journal
Diabetes Technology & Therapeutics
Published
2026-05-28
DOI
https://doi.org/10.1177/15209156261451052
Primary Topic
Diabetes and associated disorders
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article

Increased Glycation Ratio and Risk of Complications in Latent Autoimmune Diabetes in Adults Compared With Type 1 Diabetes Onset before 30 Years: A Cohort Study

Aurora Aragón Alonso, Sandra Herranz-Antolín, Verónica Perea, Timothy C. Dunn et al.
Diabetes Technology & Therapeutics
Diabetes and associated disorders
article

Increased Glycation Ratio and Risk of Complications in Latent Autoimmune Diabetes in Adults Compared With Type 1 Diabetes Onset before 30 Years: A Cohort Study

Aurora Aragón Alonso, Sandra Herranz-Antolín, Verónica Perea, Timothy C. Dunn, Rebeca Reyes‐García, José Ignacio Martínez‐Montoro, Yaghoub Dabiri, Yongjin Xu, Gema López-Gallardo, Maria Asunción Martínez‐Brocca, Marı́a Durán-Martinez, Sharona Azriel, Pedro Pujante, Noemí González-Pérez de Villar, G. Cánovas-Molina, Fernando Gomez-Peralta, Antonio Jesús Amor, Estefanía Santos, Pedro José Pinés, Óscar Moreno-Pérez, Jessica Ares, Amparo Bartual, María del Carmen López-García, Cristina Serrano, Rosa Márquez-Pardo, Ignacio Conget, Diego Bellido, Manuel Gargallo, Cristina Tejera, Miguel Brito-Sanfiel, Virginia Bellido
article en

Abstract

Objective: To clarify the distinctions between Latent Autoimmune Diabetes in Adults (LADA) and Type 1 diabetes (T1D) diagnosed < 30 years using continuous glucose monitoring (CGM) metrics, glycation rate, and risk of complications. Design and Methods: Multicenter, cross-sectional, observational study including subjects with T1D onset < 30 years (T1D cohort) and those classified as LADA diagnosed ≥ 30 years (LADA cohort) with ≥ 80% CGM coverage 56 days prior to glycated hemoglobin (HbA1c). Logistic regression was used to model the risk of complications. Results: T1D ( n = 555) and LADA ( n = 890) showed different ages (43 vs. 58 years; P < 0.001), age at diagnosis (16 vs. 43 years; P < 0.001), diabetes duration (26.8 vs. 15.1 years; P < 0.001), HbA1c (7.2 vs. 7.3%; P = 0.017), microvascular complications (35 vs. 23%; P < 0.001), and daily total and basal insulin [0.63 vs. 0.59 U/(kg·d); P = 0.006 and 0.35 vs. 0.32 U/(kg·d); P = 0.002]. After adjusting for diabetes duration, T1D exhibited higher time below range (TBR70: 3.9 vs. 3.0%; P < 0.001; TBR54: 0.5 vs. 0.3%; P < 0.001) and variability [coefficient of variation (CV): 35.6 vs. 34.2%; P < 0.001; within-day CV: 31.4 vs. 30.3%; P < 0.001]. Personal glycation ratio was higher in LADA after adjusting for diabetes duration and body mass index (66.5 vs. 64.9%; P < 0.001). Estimated risks of macrovascular and microvascular complications were higher in LADA than in T1D [12.6% (95% CI 9.7–15) vs. 3.8% (95% CI 2.1–5.6) and 46.1% (95% CI 40.4–52.0) vs. 29.1% (95% CI 25.1–33.5)] after adjusted for diabetes duration. Conclusions: LADA cohort showed a higher glycation rate and lower time in hypoglycemia and variability. Microvascular complications were more common in T1D, but after adjusting for diabetes duration, macrovascular and microvascular risks were greater in LADA.

Diabetes Technology & Therapeutics
University of Alicante (ES), Universitat de València (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital General De Segovia (ES), Hospital Universitario Virgen Macarena (ES), Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (ES), Hospital Universitario de Guadalajara (ES), Hospital Clínico Universitario de Valencia (ES), University Hospital Mútua de Terrassa (ES), Hospital Universitario de Getafe (ES), Hospital Universitario Puerta de Hierro Majadahonda (ES), Hospital Clínic de Barcelona (ES), Hospital Universitario de Burgos (ES), Diabetes Care Center (US), Instituto Bernabeu (ES), Hospital Juan Ramón Jiménez (ES), Hospital Universitario Fundación Jiménez Díaz (ES), Hospital Universitario Central de Asturias (ES), Hospital General Universitario de Alicante Doctor Balmis (ES), Servicio de Salud de Castilla La Mancha (ES), Hospital Universitario de Fuenlabrada (ES), Hospital Universitario Virgen de la Arrixaca (ES), Complejo Hospitalario Torrecárdenas (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Universitario Infanta Sofía (ES), Hospital Universitario Infanta Leonor (ES), Complejo Hospitalario Universitario de Ferrol (ES), Abbott Diabetes Care (United States), Universidad Europea de Madrid (ES)
Good health and well-being
Openalex Percentile: Top 6%
Diabetes and associated disorders
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