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Latent autoimmune diabetes in adults — SCE Endocrinology MCQ

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HardDiabetesLatent autoimmune diabetes in adultsSCE Endocrinology

A 37-year-old woman labelled as having type 2 diabetes is reviewed because HbA1c remains 91 mmol/mol despite metformin and gliclazide. BMI is 22 kg/m² and she has lost 6 kg over 4 months. Her father developed diabetes at age 60, and capillary ketones are 0.7 mmol/L. What is the most appropriate next investigation?

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Correct answer: B — GAD antibody and fasting C-peptide measurement

The low BMI, weight loss and treatment failure raise concern for autoimmune diabetes in adulthood. GAD antibodies and C-peptide help distinguish LADA/type 1 diabetes from insulin-resistant type 2 diabetes. An OGTT would not resolve the aetiology once diabetes is already established.

Reference: NICE NG17, Diabetes UK professional guidance