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Comparison between LADA, type 1 diabetes and type 2 diabetes

LADA is neither classified as type 2 diabetes or type 1 diabetes but considered somewhere in between. It is a form of type 1 diabetes that has similarities and differences to both type 1 and type 2 diabetes.[2]

• Onset: Type 1 diabetes onsets rapidly and at a younger age than does LADA. Both LADA and type 2 onset is slow, over many months or years.

• Family history: There is often an absence of family history of type 2 diabetes in a LADA patient's family, but a genetic marker of HLA genes found in type 1 and LADA, but not in type 2 diabetes. LADA does not affect children and is uncommon in young adults (age 25–30). It is most often diagnosed after age 35.

• Antibodies: Persons with type 1 diabetes and LADA usually test positive for certain (same) antibodies that are not present in type 2 diabetes.

• GAD antibodies: Persons with LADA usually test positive for GAD antibodies, whereas in type 1 diabetes these antibodies are more commonly seen in adults rather than in children.[2][10]

• Insulin sensitivity: Persons with LADA are not insulin resistant (and may be insulin sensitive) as in the case of type 2 diabetes and prediabetes.

• Lifestyle and excess weight: Type 2 diabetes may onset as a result of a sedentary lifestyle and excess body weight (especially when excess weight is carried about the center, or in those with an "apple" shaped body). These factors are not thought of as contributing factors to the onset of type 1 diabetes or LADA. Persons with LADA are often normal body weight or thin and are not insulin resistant. Persons with type 2 diabetes are often insulin resistant and overweight.

• Prognosis: About 80% of all persons initially diagnosed with type 2, who also have GAD antibodies, will become insulin dependent within six years. Those with both GAD and IA2 antibodies will become insulin dependent sooner. LADA occurs slowly, but progresses towards insulin dependency.[5]

• Treatment: Although LADA may appear to initially respond to similar treatment (lifestyle and medications) as type 2 diabetes, it will not halt or slow the progression of beta cell destruction. People with LADA will eventually become insulin dependent.

Latent autoimmune diabetes

Latent autoimmune diabetes in adults (LADA) is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas. Simply stated, autoimmune disorders, including LADA, are an "allergy to self."

In its early stages LADA typically presents as type 2 diabetes and is often misdiagnosed as such. However, LADA more closely resembles type 1 diabetes and shares common physiological characteristics of type 1 for metabolic dysfunction, genetics, and autoimmune features, but LADA does not affect children and is classified distinctly as being separate from juvenile diabetes.[1][2][7]

FDA's Role in Regulating Food and Diet

FDA's Center for Food Safety and Applied Nutrition (CFSAN), in conjunction with the Agency's field staff, is responsible for promoting and protecting the public's health by ensuring that the nation's food supply is safe, sanitary, wholesome, and honestly labeled. The Center's primary responsibilities include:

• the safety of substances added to food, e.g., food additives (including ionizing radiation) and color additives
  
• the safety of foods and ingredients developed through biotechnology
  
• seafood Hazard Analysis and Critical Control Point (HACCP) regulations
  
• regulatory and research programs to address health risks associated with foodborne chemical, and biological contaminants
  
• regulations and activities dealing with the proper labeling of foods (e.g., ingredients, nutrition health claims) and cosmetics
  
• regulations and policy governing the safety of dietary supplements, infant formulas, and medical foods
  
• safe and properly labeled cosmetic ingredients and products
  
• food industry postmarket surveillance and compliance
  
• consumer education and industry outreach
  
• cooperative programs with state and local governments
  
• international food standard and safety harmonization efforts

Dietary Supplements

Congress defined the term "dietary supplement" in the Dietary Supplement Health and Education Act (DSHEA) of 1994. A dietary supplement is a product taken by mouth that contains a "dietary ingredient" intended to supplement the diet. The "dietary ingredients" in these products may include: vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, glandulars, and metabolites. Dietary supplements can also be extracts or concentrates, and may be found in many forms such as tablets, capsules, softgels, gelcaps, liquids, or powders. They can also be in other forms, such as a bar, but if they are, information on their label must not represent the product as a conventional food or a sole item of a meal or diet. Whatever their form may be, DSHEA places dietary supplements in a special category under the general umbrella of "foods," not drugs, and requires that every supplement be labeled a dietary supplement.

In October 1994, the Dietary Supplement Health and Education Act (DSHEA) was signed into law by President Clinton. Before this time, dietary supplements were subject to the same regulatory requirements as were other foods. This new law, which amended the Federal Food, Drug, and Cosmetic Act, created a new regulatory framework for the safety and labeling of dietary supplements.

Under DSHEA, a firm is responsible for determining that the dietary supplements it manufactures or distributes are safe and that any representations or claims made about them are substantiated by adequate evidence to show that they are not false or misleading. This means that dietary supplements do not need approval from FDA before they are marketed. Except in the case of a new dietary ingredient, where pre-market review for safety data and other information is required by law, a firm does not have to provide FDA with the evidence it relies on to substantiate safety or effectiveness before or after it markets its products.

Also, manufacturers do not need to register themselves nor their dietary supplement products with FDA before producing or selling them. Currently, there are no FDA regulations that are specific to dietary supplements that establish a minimum standard of practice for manufacturing dietary supplements. However, FDA intends to issue regulations on good manufacturing practices that will focus on practices that ensure the identity, purity, quality, strength and composition of dietary supplements. At present, the manufacturer is responsible for establishing its own manufacturing practice guidelines to ensure that the dietary supplements it produces are safe and contain the ingredients listed on the label.

People with diabetes should be sure to consult a doctor or pharmacist before purchasing or taking any supplement. Many supplements contain active ingredients that have strong biological effects and their safety is not always assured in all users. Other supplements may interact with prescription and over-the-counter medicines. By taking these products, you may be placing yourself at risk.

Overweight, Obesity, and Weight-Loss

More than 60 percent of U.S. adults are either overweight or obese, according to the Centers for Disease Control and Prevention (CDC). While the number of overweight people has been slowly climbing since the 1980s, the number of obese adults has nearly doubled since then.

Excess weight and physical inactivity account for more than 300,000 premature deaths each year in the United States, second only to deaths related to smoking, says the CDC. People who are overweight or obese are more likely to develop heart disease, stroke, high blood pressure, diabetes, gallbladder disease and joint pain caused by excess uric acid (gout). Excess weight can also cause interrupted breathing during sleep (sleep apnea) and wearing away of the joints (osteoarthritis).

To address the public health epidemic of being overweight or obese, former Surgeon General David Satcher issued a "call to action" in December 2001. Satcher's report, The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity, outlined strategies that communities can use in helping to address the problems. Those options included requiring physical education at all school grades, providing more healthy food options on school campuses, and providing safe and accessible recreational facilities for residents of all ages.

Using the food label to help with food choices

Under regulations from the Food and Drug Administration of the Department of Health and Human Services and the Food Safety and Inspection Service of the U.S. Department of Agriculture, the food label offers more complete, useful and accurate nutrition information than ever before.

With today's food labels, consumers get

• nutrition information about almost every food in the grocery store
  
• distinctive, easy-to-read formats that enable consumers to more quickly find the information they need to make healthful food choices
  
• information on the amount per serving of saturated fat, cholesterol, dietary fiber, and other nutrients of major health concern
  
• nutrient reference values, expressed as % Daily Values, that help consumers see how a food fits into an overall daily diet
  
• uniform definitions for terms that describe a food's nutrient content--such as "light," "low-fat," and "high-fiber"--to ensure that such terms mean the same for any product on which they appear
  
• claims about the relationship between a nutrient or food and a disease or health-related condition, such as calcium and osteoporosis, and fat and cancer. These are helpful for people who are concerned about eating foods that may help keep them healthier longer.
  
• standardized serving sizes that make nutritional comparisons of similar products easier
  
• declaration of total percentage of juice in juice drinks. This enables consumers to know exactly how much juice is in a product.

Begin with the Nutrition Facts panel, usually on the side or back of the package. The Nutrition Facts panel has two parts: The main or top section, which contains product-specific information (serving size, calories, and nutrient information) that varies with each food product; and the bottom part, which contains a footnote. This footnote is only on larger packages and provides general dietary information about important nutrients.

Several features of the Nutrition Panel help people with diabetes manage their diets. First of all, serving sizes now are more uniform among similar products and reflect the amounts people actually eat. The similarity makes it easier to compare the nutritional qualities of related foods. People who use the Exchange Lists should be aware that the serving size on the label may not be the same as that in the Exchange Lists. For example, the label serving size for orange juice is 8 fluid ounces (240 milliliters). In the exchange lists, the serving size is 4 ounces (one-half cup) or 120 mL. So, a person who drinks one cup of orange juice has used two fruit exchanges.

The label also gives grams of total carbohydrate, protein and fat, which can be used for carbohydrate counting. The values listed for total carbohydrates include all carbohydrates, including dietary fiber and sugars listed below it. Not singled out is complex carbohydrates, such as starches. The sugars include naturally present sugars, such as lactose in milk and fructose in fruits, and those added to the food, such as table sugar, corn syrup, and dextrose. The listing of grams of protein also is helpful for those restricting their protein intake, either to reduce their risk of kidney disease or to manage the kidney disease they have developed.

Elsewhere on the label, consumers may find claims about the food's nutritional benefits. These claims signal that the food contains desirable levels of certain nutrients. Some claims, such as "low fat," "no saturated fat," and "high fiber," describe nutrient levels. Some of these are particularly interesting to people with diabetes because they highlight foods containing nutrients at beneficial levels.

Other claims, called health claims, show a relationship between a nutrient or food and a disease or health condition. FDA has authorized a number of claims, which are based on significant scientific agreement. Three claims that relate to heart disease are of particular interest to people with diabetes:

• A diet low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
• A diet rich in fruits, vegetables and grain products that contain fiber, particularly soluble fiber, and are low in saturated fat and cholesterol may help reduce the risk of coronary heart disease.
• Soluble fiber from whole oats, as part of a diet low in saturated fat and cholesterol, may help reduce the risk of coronary heart disease.

Nutrient and health claims can be used only under certain circumstances, such as when the food contains appropriate levels of the stated nutrients.