AbstractInsulin autoimmune syndrome (IAS) and type B insulin resistance syndrome (B-IRS)
are rare autoimmune dysglycemia syndromes, but their treatment and prognosis are
different. This study aimed to provide a basis for the clinical differential
diagnosis of IAS and B-IRS. This was a retrospective study of the medical
records of all patients diagnosed with IAS or B-IRS between January 2006 and
March 2018 at the Chinese PLA General Hospital. Demographic, clinical,
biochemistry, treatment, and follow-up data were examined. There were several
different biochemical parameters between IAS (n=13) and B-IRS
(n=6): white blood count (WBC, 7.05±3.06 vs.
2.70±0.73×109/l, p=0.004),
platelet (249±56.6 vs.
111±68.0×109/l, p<0.001), serum
creatine (59.0±17.8 vs. 43.1±7.05 μmol/l,
p=0.013), serum albumin (42.3±5.17 vs. 33.6±3.40
g/l, p=0.002), triglyceride (median, 1.33 (1.01, 1.93) vs. 0.56
(0.50, 0.79) mmol/l, p=0.002), plasma IgG (1183±201 vs.
1832±469 mg/ml, p=0.018), IgA (328±140 vs.
469±150 mg/ml, p=0.018), and C3
(128±23.4 vs. 45.3±13.5 mg/l, p<0.001).
Fasting insulin in the IAS and B-IRS patients was high (299–4708 vs.
118–851 mU/l, p=0.106), and there was a
difference in 2 h oral glucose tolerance test insulin
(4217–8343 mU/l vs.
274–1143 mU/l, p=0.012). Glycated hemoglobin
(HbA1c) in the B-IRS patients was higher than in IAS patients (114±14.4.
vs. 40.6±8.89 mmol/mol, p<0.001). Serum
insulin-like growth factor-1 (IGF-1) was lower in all B-IRS patients
(25±0.00 vs. 132±52.7 ng/ml, p<0.001).
Although IAS and B-IRS are autoimmune hyperinsulinemic dysglycemic syndromes,
several clinical parameters (body mass index, HbA1c, WBC, platelet, albumin,
triglyceride, IgG, C3, and IGF-1) are different between these two syndromes.
Type B insulin resistance syndrome with Scleroderma successfully treated with multiple immune suppressants after eradication of Helicobacter pylori infection: a case report