Sustained metabolic control in latent autoimmune diabetes in adults (LADA) with semaglutide therapy in a patient with multiple autoimmune comorbidities: a case report and literature review.

内容摘要

Latent Autoimmune Diabetes in Adults (LADA) is a complex form of autoimmune diabetes characterised by the presence of pancreatic autoantibodies and a progressive β-cell decline, often leading to eventual insulin dependence. Evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RAs)-notably semaglutide-in LADA remains limited. Here, we present the case of a 55-year-old woman, initially diagnosed with type 2 diabetes mellitus, who exhibited class II obesity and multiple autoimmune disorders, including vitiligo, celiac disease, autoimmune thyroiditis, and undifferentiated arthritis. Laboratory evaluation revealed positive anti-glutamic acid decarboxylase antibodies and preserved fasting C-peptide, prompting a revised diagnosis of LADA. Given her obesity and residual β-cell function, metformin was discontinued and semaglutide initiated. Over five years of follow-up, the patient maintained durable glycemic control, significant weight loss, and stable β-cell function without requiring insulin. A temporary transition from injectable to oral semaglutide due to supply constraints did not compromise metabolic stability. To contextualize these findings, we conducted a systematic review of literature regarding semaglutide in LADA, identifying only two eligible case reports-underscoring the paucity of data. This case highlights the potential value of early LADA recognition in adults with preserved β-cell function, enabling a personalised approach with semaglutide to achieve metabolic control and possibly delay insulin requirement. Larger, prospective studies are warranted to elucidate the role of GLP-1 receptor agonists in LADA management and to define predictors of therapeutic response.