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Latent autoimmune diabetes in adults — SCE Endocrinology MCQ

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HardDiabetes mellitusLatent autoimmune diabetes in adultsSCE Endocrinology

A 46-year-old lean man labelled with type 2 diabetes has rapid failure of metformin and gliclazide over 9 months. HbA1c is 86 mmol/mol, ketones are 0.9 mmol/L, C-peptide is low and GAD antibodies are positive. What is the most likely diagnosis?

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Correct answer: B — Latent autoimmune diabetes in adults

Latent autoimmune diabetes in adults is best because adult-onset autoimmune beta-cell failure is supported by leanness, low C-peptide and GAD antibody positivity. The alternatives are less appropriate because MODY usually has preserved C-peptide and family pattern; type 2 diabetes is less likely with antibodies and low C-peptide; pancreatic diabetes needs pancreatic disease; factitious hyperglycaemia does not fit objective ketosis risk. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG17; NICE NG28