Adult-onset autoimmune diabetes is a heterogeneous disease that is characterized by a reduced genetic load, a less intensive autoimmune process and a mild metabolic decompensation at onset compared with young-onset type 1 diabetes mellitus (T1DM). The majority of patients with adult-onset autoimmune diabetes do not require insulin treatment for at least 6 months after diagnosis. Such patients are defined as having latent autoimmune diabetes in adults (LADA), which is distinct from classic adult-onset T1DM. The extensive heterogeneity of adult-onset autoimmune diabetes is apparent beyond the distinction between classic adult-onset T1DM and LADA. LADA is characterized by genetic, phenotypic and humoral heterogeneity, encompassing different degrees of insulin resistance and autoimmunity; this heterogeneity is probably a result of different pathological mechanisms, which have implications for treatment. The existence of heterogeneous phenotypes in LADA makes it difficult to establish an a priori treatment algorithm, and therefore, a personalized medicine approach is required. In this Review, we discuss the current understanding and gaps in knowledge regarding the pathophysiology and clinical features of adult-onset autoimmune diabetes and highlight the similarities and differences with classic T1DM and type 2 diabetes mellitus.

与年轻发病的1型糖尿病（T1DM）相比，成人发病的自身免疫性糖尿病是一种异质性疾病，其特点是遗传负荷降低，自身免疫过程强度降低以及发病时轻度的代谢失代偿。诊断为成年后自身免疫性糖尿病的大多数患者在至少6个月内不需要胰岛素治疗。此类患者被定义为成人潜伏性自身免疫性糖尿病（LADA），与经典的成人发作性T1DM不同。成人发作自身免疫性糖尿病的广泛异质性超出了经典的成人发作T1DM和LADA之间的区别。LADA的特点是遗传，表型和体液异质性，包括不同程度的胰岛素抵抗和自身免疫。这种异质性可能是不同病理机制的结果，对治疗有影响。LADA中异质表型的存在使得难以建立先验治疗算法，因此，需要个性化的医学方法。在本综述中，我们讨论了关于成人发作的自身免疫性糖尿病的病理生理学和临床特征的当前认识和知识空白，并强调了与经典T1DM和2型糖尿病的异同。