Autoimmune-Related Severe Hyperinsulinemic Dysglycemia in Clinical Practice—22 Case Analysis

Presentation Number: LBSat-49
Date of Presentation: April 2nd, 2016

Guoqing Yang*1, Jing-tao Dou2, Yiming Mu3 and Zhaohui Lv4
1Chinese PLA General Hospital, Beijing, CHINA, 2Chinese PLA General Hospital, Beijing, China, 3Chinese People’s Liberation Army General Hospital, Beijing, China, 4Chinese PLA General Hospital, China

Abstract

Background:Autoimmune mechanism can affect many endocrine diseases, one of the pathogenic mechanism is to interfere the hormones by binding the hormone or its receptor, producing blocking or enhancing the hormone’s effect. The autoimmune syndromes that cause clinical hyperinsulinemic dysglycemia are rare, especially insulin autoimmune syndrome(IAS) and type B insulin resistance(B-SIR) by the autoantibodies directing insulin or insulin receptors. But the clinical spectrum may be different between these two syndromes.

Objective: The aim of this study is to explore differences between the two main types of autoimmune-related hyperinsulinemic dysglycemia (IAS and B-SIR) by retrospectively reviewing our patients diagnosed as insulin autoimmune syndrome and type B insulin resistance during past 5 years.

Results: Of 22 patients, 17(male: female 11:6, mean age 59.4+13.4 years ) were IAS, and 5 were B-SIR(male: female 4:1, mean age 56.0+11.2 years ). 13 patients had the drug history of methimazole for Graves’ disease, 4 diabetes received insulin therapy.  All 5 B-SIR patients had history of systemic autoimmune disease, two of them had H. pylori infection. All 22 patients experienced dysglycemia, but the duration of disease was statistically different(2.96+3.94m vs 26.6+28.2m, p=0.002),and all IAS patients had transient and spontaneous hypoglycemia, mild hyperglycemia occurred in IAS diabetic patients. All patients’ serum insulin (fasting and 2-hours post-glucose loading) were extremely elevated, fasting insulin was 70.2-5743 mu/L vs 118-851mu/L(p=0.127), insulin of 2h OGTT was 73.8-13216mu/L vs 274-1143 mu/L(p=0.025). Although, all of these 22 patiens’ serum insulin elevated, the serum IGF-1 was significantly different between the two groups, it was in normal range in all IAS patients, otherwise, IGF-1 decreased in all B-SIR patients. HbA1c in the B-SIR patients were significantly higher than that in IAS patients ( 12.6+1.47% vs 6.71+1.83%,p<0.01). Interestingly, there were several serological and biochemical parameters significantly different  between two groups, such as plasma WBC(6.49±2.93*109 /L vs 2.50±0.76*109 /L, p=0.009), platelet(227±58*109 /L vs 98.4±67.3*109/L, P<0.001), serum Creatine(62.4±16.8ummol/L vs 42.2±7.47ummol/L , p=0.018), serum albumin(42.8±5.08g/L vs 33.0±3.41 g/L, p=0.001),Ig G(1208±260mg/ml vs 1985±317 mg/ml, p=0.003) and C3(125±23.4 mg/L vs 44.6±15.0 mg/L,p<0.001).

Conclusions: Although IAS and B-SIR are all the autoimmune-related hyperinsulinemic dysglycemic syndromes, and clinical confirmation is always depended on the presence of anti-insulin antibody or anti-insulin receptor antibody, we found several clinical parameters(WBC, platelet, albumin, Ig G, C3, IGF-1 and so on) were quite different between these two syndromes, so this may be helpful for the differential diagnoses in the hyperinsulinemia dysglycemic syndromes.

 

Disclosure: YM: Speaker, Astra Zeneca, Speaker, Sanofi, Speaker, Eli Lilly, Speaker, Novo Nordisk. Nothing to Disclose: GY, JTD, ZL