Semaglutide sustains metabolic control, weight loss, and β-cell function in LADA patient with multiple autoimmune comorbidities

Latent Autoimmune Diabetes in Adults (LADA) is a complex form of autoimmune diabetes often misdiagnosed as type 2 diabetes mellitus (T2DM). It's characterized by progressive β-cell decline and the presence of pancreatic autoantibodies, frequently necessitating eventual insulin dependence. Current standard-of-care for LADA often involves insulin, but there's a growing interest in therapies that can preserve residual β-cell function. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide have shown promise in T2DM for glycemic control and weight loss, but their role in LADA, particularly in patients with multiple autoimmune comorbidities, remains underexplored. This gap limits personalized treatment strategies for this complex patient population.

Researchers present a case report of a 55-year-old woman initially misdiagnosed with type 2 diabetes mellitus who presented with class II obesity and multiple autoimmune disorders including vitiligo, celiac disease, autoimmune thyroiditis, and undifferentiated arthritis. Following laboratory evaluation, which revealed positive anti-glutamic acid decarboxylase antibodies and preserved fasting C-peptide, her diagnosis was revised to Latent Autoimmune Diabetes in Adults (LADA). Given her obesity and residual β-cell function, metformin was discontinued, and semaglutide was initiated. The patient was followed for five years, monitoring glycemic control, weight, and β-cell function. A temporary switch from injectable to oral semaglutide was also observed for its impact on metabolic stability.

Over five years of follow-up, the patient demonstrated sustained positive outcomes. The initial diagnosis of LADA was confirmed by positive anti-glutamic acid decarboxylase antibodies and preserved fasting C-peptide levels.

Semaglutide therapy led to durable glycemic control, significant weight loss, and stable β-cell function without the need for insulin. Throughout the five-year period, the patient maintained metabolic stability, even during a temporary transition from injectable to oral semaglutide due to supply constraints. This suggests a robust and adaptable therapeutic effect. The systematic review conducted alongside the case report highlighted the extreme paucity of data, identifying only two other eligible case reports on semaglutide in LADA, underscoring the novelty and importance of these findings. The patient's class II obesity was also effectively managed, contributing to overall metabolic improvement.