RCT on Verapamil effects on beta cell function and glucose homeostasis in LADA

A randomized controlled trial testing for beneficial effects by Verapamil on beta cell function and glucose homeostasis in adults with LADA diabetes

A subgroup of adult-onset diabetes needs a new therapy. LADA (Latent Autoimmune Diabetes in the Adult) is a large subgroup of patients in whom diabetes is diagnosed at adult age. In Norway, about 10% with a diagnosis of diabetes > 35 years of age are classified as LADA. LADA patients display signs of autoimmunity with the presence of autoantibodies. Antibodies against Glutamic Acid Decarboxylase, GADA, are typically seen in LADA.

Not so long ago LADA patients were thought to have type 2 diabetes. This was because they did not need treatment with insulin when their diabetes was discovered just as type 2 diabetes. But because of LADA patients were found to have antibodies – similar to Type 1 diabetes - their diabetes is caused in part by autoimmunity. LADA has sometimes been called diabetes 1.5 because it has similarities both to type 1 and type 2 diabetes.

What is the best treatment for LADA patients? Most of them are treated as type 2 diabetes. But on such treatment very many LADA patients develop with time a need for insulin - much before individuals with type 2 diabetes. And this difference from type 2 diabetes occurs because the autoimmunity that is part of LADA diabetes destroys the insulin producing beta cells. This is very unfortunate, since lack of an individual’s own insulin increases the risk of diabetic complications. A treatment that stops or at least retards the process of beta cell destruction is needed – but has so far not been found.

Recent studies in patients with newly-onset type 1 diabetes has shown that a time-honored drug Verapamil can uphold remaining capacity for insulin secretion. Notably these beneficial effects were achieved without any important side effects. With this information at hand, we want to test for beneficial effects of Verapamil in LADA patients. Our study is double-blinded, so that neither we nor the patients will know if they receive Verapamil or a control table without the drug (called placebo). The participants will take one tablet a day during 2 years after which we will test how much effect the treatment with Verapamil has had on the patient’s own insulin secretion. If, as we believe we get a positive result, then we have arrived at a therapy that works in LADA patients.