One Case Report Of Exogenous Insulin Antibody Syhdrome And Literature Review

Background and Objective:With the development of society and the change of lifestyle,the prevalence of diabetes is increasing year by year.At present,insulin is still the dominant treatment for diabetes.In recent decades,a series of clinical symptoms caused by insulin antibody induced by exogenous insulin have been reported.In order to distinguish it from insulin autoimmune syndrome(IAS),it is called exogenous insulin antibody syndrome or exogenous insulin autoimmune syndrome(EIAS).At present the clinical features,diagnostic criteria and treatment of EIAS is not fully clear,the study reported 1 EIAS cases and analyzed through literature review,summarized its general characteristics,the main points of diagnosis and treatment strategies,expecting to improve the knowledge of the disease,providing information and direction for furture researches.Research methods:The study reported 1 case diagnosed with type 2 diabetes mellitus and exogenous insulin antibody syndrome,and retrieved by relevant keywords in several English and Chinese databases and included EIAS cases in nearly 20 years,summarized clinical features,laboratory results and treatment methods in EIAS patients.Results:A total of 61 Chinese or English literatures were included,about 138 cases from 7 different countries and regions.The majority of the included patients are male(male 67.67%vs female 32.33%),and 68.84%are elderly patients.In the classification of diabetes,the majority of patients are type 2 diabetes(81.82%)and have medium and long course of disease.EIAS can be induced by different types of insulin,among which insulin analogues are most common.Although there are related reports on the amount and duration of insulin use,there is no clear correlation at present.The clinical manifestations of EIAS patients include the following characteristics:recurrent spontaneous hypoglycemic episodes,insulin resistance,large blood glucose fluctuations,and a small number of patients may be accompanied by allergic reactions.The level of HbAlc and postprandial blood glucose in most patients do not meet the target,and hyperinsulinemia and "separation phenomenon" can be observed by detecting insulin and C-peptide.Most patients are positive for IAA(97.64%).Hypoglycemic episodes may be related to the internal environment of low PH,prolonged insulin action by antibodies,and hyperglycemic stimulation.In all reports,EIAS patients have a good prognosis.Symptoms relieve for 1-2 months after original insulin discontinuation,and IAA gradually turn negative after discontinuation.Conclusions:EIAS is a clinical syndrome caused by exogenous insulin antibody,which is characterized by spontaneous recurrent hypoglycemia,large blood glucose fluctuation,daytime hyperglycemia and insulin resistance.EIAS can be considered when conditions include history of insulin use,typical clinical manifestations,hyperinsulinemia which is clearly separated from the c-peptide level,positive insulin antibody against exogenous insulin and other diseases that can cause hypoglycemia are excluded.Most patients have a good prognosis,and the specific treatment should be selected according to the actual condition.