Insulin administration may trigger pancreatic beta-cell destruction in patients with type 2 diabetes.

Abstract:

:Insulin administration causes various types of immune response to insulin. However, there have been no reports that insulin administration triggers pancreatic beta-cell destruction in diabetic patients. We evaluated three patients who had suffered from type 2 diabetes or impaired glucose tolerance for 5-30 years. After an episode of diabetic mononeuropathy or poor glycemic control, they started human insulin therapy. All the patients' serum or urinary C-peptide levels were preserved before insulin therapy, whereas within a few months they rapidly declined to below detection limits. A high titer of insulin antibody was detected at or after the development of insulin deficiency. Shortly after the initiation of insulin therapy, two of the patients developed an insulin allergy. Autoantibodies to GAD65 or IA-2 were negative throughout the clinical course in two cases, but transiently positive in one case. In a histological examination of pancreas tissue obtained by a pancreatic biopsy in one case, mononuclear cell infiltration into the islets was observed. They all had a type 1 diabetes high-risk HLA class II haplotype in Japanese, and class I alleles of the insulin gene VNTR. The above findings suggest that insulin administration may have triggered pancreatic beta-cell destruction in these patients.

authors

Nakamura M,Nishida W,Yamada Y,Chujo D,Watanabe Y,Imagawa A,Hanafusa T,Kawasaki E,Onuma H,Osawa H,Makino H

doi

10.1016/j.diabres.2007.08.031

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

220-9

issue

2

eissn

0168-8227

issn

1872-8227

pii

S0168-8227(07)00462-7

journal_volume

79

pub_type

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