DETECTION OF LATENT AUTOIMMUNE DIABETES IN ADULTS IN A 40-YEAR-OLD WITH RHEUMATOID ARTHRITIS AND HASHIMOTO’S HYPOTHYROIDISM S Baker BS, A Johnson MD Department of Internal Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA INTRODUCTION: Latent Autoimmune Diabetes in Adults (LADA) is a heterogenous, progressive autoimmune disease differentiated from Type I and Type II diabetes due to its unique developmental course and hybrid features. LADA is characterized by age of onset >30, presence of any islet cell autoantibody, and absence of insulin requirement for 6 months after diagnosis. It is believed to be under-diagnosed in diabetics, and its detection may help patients receive better-tailored care. CASE: An obese 40-year-old male without a history of diabetes presented with polyuria, polydipsia, blurry vision, and weakness for one week with home glucose reading of 478. Medical history includes rheumatoid arthritis treated with adalimumab, and family history of Type II Diabetes. Physical exam revealed an obese male with tachycardia, elevated blood pressure. Lab evaluation indicated blood glucose of 337, and findings consistent with borderline diabetic ketoacidosis (DKA). HbA1c was 10.0. He was admitted for intravenous fluids and insulin. Further evaluation revealed a free T4 of 0.48, TSH >84.0 with positive Thyroid peroxidase antibodies (TPO), adding newly diagnosed Hashimoto’s hypothyroidism. His blood glucose and anion gap metabolic acidosis resolved, blood glucose improved, and he was also started on levothyroxine. Further history revealed treatment for hyperthyroidism as a teenager. Given his body habitus, age of onset, and family history, he was diagnosed with type II Diabetes. However, given his rheumatoid arthritis and newly diagnosed autoimmune thyroid disease, he was tested for anti-GAD65 antibodies to screen for LADA. Lab results several days post- discharge revealed the presence of anti-GAD65 antibodies, indicating his diabetes was likely autoimmune, rather than solely metabolically derived, therefore, a diagnosis of LADA was made. DISCUSSION: Like Type II diabetes, LADA presents later in life and does not always require initial treatment with insulin. However, LADA is a progressive disease and regardless of stage at diagnosis, most patients will eventually require insulin such as those who have Type 1 DM. This case demonstrates the usefulness of testing for autoimmune diabetes in the setting of other autoimmune conditions. Prompt diagnosis of LADA can help prevent episodes of unexpected DKA in an erroneously diagnosed type II diabetic through tighter diabetes control.
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