Type B insulin resistance syndrome: a systematic review

Area of Science:

• Endocrinology
• Immunology
• Metabolic Disorders

Background:

• Type B insulin resistance syndrome (TBIRS) is a rare autoimmune disorder characterized by severe insulin resistance.
• It frequently co-occurs with other autoimmune conditions, most commonly systemic lupus erythematosus.
• The primary clinical manifestation is hyperglycemia that is difficult to manage, even with high insulin doses.

Purpose of the Study:

• To review and synthesize the clinical, laboratory, and treatment features of Type B insulin resistance syndrome.
• To analyze data from existing literature to understand disease characteristics and outcomes.
• To identify factors associated with remission and relapse in TBIRS patients.

Main Methods:

• A comprehensive literature review was conducted using PubMed, Virtual Health Library, and Cochrane databases.
• Data from 182 selected papers, assessing 119 clinical cases, were analyzed using REDCap and R statistical software.
• Key data points included demographics, clinical features, laboratory findings (anti-insulin receptor antibodies), treatments, and outcomes (remission, relapse, mortality).

Main Results:

• The study analyzed 119 cases, predominantly affecting females (76.5%) and African-Americans (42.9%), with an average age of 44.
• Anti-insulin receptor antibodies were positive in 44.2% of cases. Hyperglycemia and autoimmune diseases were common.
• Remission was achieved in 69.7% of cases, with combined immunosuppressive therapy showing a positive correlation with remission (p=0.002).

Conclusions:

• Type B insulin resistance syndrome presents with severe, difficult-to-control diabetes and is associated with autoimmune diseases.
• Immunomodulatory and combined immunosuppressive therapies are crucial for improving remission rates.
• While remission rates are significant, the mortality rate remains notable at 15.38%, highlighting the severity of the syndrome.