Case Report: Latent autoimmune diabetes in two young female patients successfully treated with oral semaglutide and basal insulin.

Latent autoimmune diabetes in youth (LADY) is a poorly characterized form of autoimmune diabetes with onset between 8 and 29 years of age and with slow progression toward insulin dependence, similarly to latent autoimmune diabetes of the adult (LADA), which leads to diagnostic difficulties and possibly to therapeutic implications. In this case series, we discuss two cases of juvenile- and young adult-onset autoimmune diabetes with very low insulin need at least after diagnosis and the efficacy of treatment with semaglutide. In case 1, a 20-year-old woman with obesity (31.8 kg/m) with a non-ketoacidotic onset of diabetes was initially put on metformin and basal insulin. Previous ultrasound of the abdomen showed a hyperechogenic liver pattern. Tests showed high-titer multiple diabetes-related autoantibodies positivity, but still detectable C-peptide levels; thus, metformin was stopped and semaglutide was started. After 12 months, the patient still continues oral semaglutide and basal insulin, with detectable C-peptide, and has experienced significant weight loss (-20 kg) and resolution of liver steatosis. In case 2, a 13-year-old girl was diagnosed with autoimmune diabetes, with tests showing high-titer multiple diabetes-related autoantibodies positivity. She was initially put on multiple daily insulin injections (MDI). After almost 2 years, presenting to our care with still detectable C-peptide, we decided to stop meal-time insulin and to start oral semaglutide. After 15 months of follow-up on the latter treatment, the patient presents optimal glycemic control and increased C-peptide levels. This is the first case series that shows the possibility of treating LADY with oral semaglutide and basal insulin with optimal glycometabolic outcomes. Moreover, semaglutide treatment also had beneficial effects on weight control and non-confirmed effects on metabolic dysfunction-associated steatotic liver disease (MASLD).