Analysis of the clinical characteristics of insulin autoimmune syndrome induced by exogenous insulin in diabetic patients
Open Access
- 7 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Diabetology & Metabolic Syndrome
- Vol. 13 (1), 1-8
- https://doi.org/10.1186/s13098-021-00658-z
Abstract
The exact incidence, clinical features and uniform diagnostic criteria of exogenous insulin autoimmune syndrome (EIAS) are still unclear. The purpose of this study is to explore the clinical characteristics of EIAS and to provide a structural approach for clinical diagnosis, treatment and prevention. The literature on EIAS in Chinese and English from 1970 to 2020 was collected for retrospective analysis. A total of 122 patients (33 males and 73 females) were included in the study with a median age of 67 years (range 14–86) and a median HbA1c of 7.7%. EIAS mainly occurred in type 2 diabetes mellitus patients using premixed insulin. Symptoms manifested were hypoglycemia in 86.54%, recurrent episodes of symptomatic hypoglycemia in 35.58%, nocturnal hypoglycemia along with daytime hyperglycemia in 21.15% and recurrent hypoglycemia after discontinued insulin in 64.43%. The onset of symptoms occurred at night, in the early morning or during fasting, ranging from a few days to 78 months after the administration of insulin. The mean blood glucose level during the hypoglycemic phase was 2.21 mmol/L (range 1–3.4), and the serum insulin levels were mainly ≥ 100 U/mL and were associated with low C-peptide levels (≤ 10 ng/ml). Insulin autoantibodies (IAAs) were positive in all EIAS patients. The 75-g extended oral glucose tolerance test (OGTT) mainly showed a diabetic curve. Pancreatic imaging was unremarkable. Withdrawal of insulin alone or combination of oral hypoglycemic agents or replacement of insulin formulations or with corticosteroid treatment eliminated hypoglycemia in a few days to 3 months. IAA turned negative in 6 months (median, range 1–12). No hypoglycemia episodes were observed at a median follow-up of 6 months (range 0.5–60). EIAS is an autoimmune disease caused by insulin-binding antibodies in susceptible subjects. Insulin antibodies change glucose dynamics and could increase the incidence of hypoglycemic episodes. Detection of insulin antibodies is the diagnostic test. Changing therapeutic modalities reduced the incidence of hypoglycemic episodes.Keywords
Funding Information
- National Natural Science Foundation of China (81900344)
- Natural Science Foundation of Hunan Province (2018JJ3795)
- State Administration of Traditional Chinese Medicine of Hunan (201335)
This publication has 27 references indexed in Scilit:
- Immunological mechanism underlying the immune response to recombinant human protein therapeuticsTrends in Pharmacological Sciences, 2010
- Animal insulin therapy induces a biased insulin antibody response that persists for years after introduction of human insulinActa Diabetologica, 2009
- Characteristics of the antibodies of two patients who developed daytime hyperglycemia and morning hypoglycemia because of insulin antibodiesDiabetes Research and Clinical Practice, 2009
- Drug-induced insulin autoimmune syndromeDiabetes Research and Clinical Practice, 2009
- Severe insulin resistance due to anti‐insulin antibodies: response to plasma exchange and immunosuppressive therapyDiabetic Medicine, 2009
- The double whammy of endogenous insulin antibodies in non-diabetic subjectscclm, 2008
- Differential Immunogenetic Determinants of Polyclonal Insulin Autoimmune Syndrome (Hirata's Disease) and Monoclonal Insulin Autoimmune SyndromeDiabetes, 1995
- A Novel Concept of Type VII Hypersensitivity Introduced by Insulin Autoimmune Syndrome (Hirata's Disease)Autoimmunity, 1995
- HLA-DR4 genotype and insulin-processing in insulin autoimmune syndromeThe Lancet, 1992
- Increase in Insulin Antibodies During Continuous Subcutaneous Insulin Infusion and Multiple-Injection Therapy in Contrast to Conventional TreatmentDiabetes, 1987