Relapsing/Remitting Type 1 Diabetes

Presentation Number: LB MON 83
Date of Presentation: April 3rd, 2017

Matthew Spindler1, Fleur M. Keij1, Kayleigh Montana van Megen*2, Ineke Bosch3, Fleur Sprangers4, Annet van Royen-Kerkhof5, Tatjana Nikolic1 and Bart O Roep2
1Leiden University Medical Center, 2City of Hope, Duarte, CA, 3DeKinderkliniek, 4Flevo Hospital, 5Wilhelmina Children's Hospital

Abstract

Clinical Case Abstract

Objective

Type 1 diabetes (T1D) is believed to have a chronic progressive autoimmune disease process with irreversible loss of insulin secretory function, but it has been speculated that relapsing/remitting disease progression of T1D may occur.

Research Design and Methods

We reported the case of an 18-year-old female with Graves’ disease, chronic inflammatory demyelinating polyneuropathy (CIDP) and multiple islet autoantibodies, presenting with relapsing/remitting hyperglycemia. PBMCs were analyzed for islet autoimmunity.

Results

Hyperglycemia relapsed twice during CIDP flares requiring insulin therapy and remitted after intravenous immunoglobulin (IVIG) therapy improving neurological symptoms. A diagnosis of T1D was assigned on basis of insulin needs, HbA1c and islet autoantibodies. Insulin requirements disappeared following IVIG treatment and peaked during CIDP flares. Pro- and anti-inflammatory cytokine responses were noted against islet autoantigens.

Conclusions

We provided clinical evidence of relapsing/remitting T1D that associated with IVIG treatment and the regulation of islet autoimmunity. Immune modulation may restore beta cell function and glycemic control.

Nothing to Disclose: MS, FK, KM, IB, FP, ARK, TN, BR

 

Sources of Research Support: JDRF, Dutch Diabetes Research Foundation, the DON Foundation and the European Commission.

 

Nothing to Disclose: MS, FMK, KMV, IB, FS, AV, TN, BOR