Type B Insulin Resistance in Peru

Area of Science:

• Endocrinology
• Immunology
• Autoimmune Diseases

Background:

• Type B insulin resistance (IR) is a rare autoimmune disorder characterized by autoantibodies against the insulin receptor, leading to significant hyperglycemia.
• Patients often present with symptoms like cachexia, acanthosis nigricans, and hirsutism, alongside extremely high glucose levels despite high insulin doses.

Observation:

• The study details two cases of Type B IR in 42-year-old females.
• The first patient had a history of RA, SLE, and Hashimoto's thyroiditis; the second had positive TPO-ab.
• Both presented with severe hyperglycemia, cachexia, and acanthosis nigricans, with negative anti-insulin antibodies in the first case.

Findings:

• The first patient, treated with cyclophosphamide and prednisone, achieved insulin independence and an HbA1c of 5.6% within a year.
• The second patient, treated with IV insulin, also achieved insulin independence with an HbA1c of 5.6% after two years, suggesting spontaneous remission.

Implications:

• These cases highlight that Type B IR can be managed and potentially put into remission.
• Immunosuppressive therapy may be effective for some patients, while others might experience spontaneous resolution.
• Further research into the mechanisms and treatment of Type B IR is warranted.