Systematic Review-Type B Insulin Resistance With Isolated Hypoglycemia and Suppressed Insulin

Area of Science:

• Endocrinology
• Autoimmune Diseases
• Metabolic Disorders

Background:

• Type B insulin resistance syndrome is a rare autoimmune disorder impacting glucose homeostasis, typically presenting with severe insulin resistance.
• A distinct subgroup exhibits isolated hypoglycemia with suppressed insulin levels, diverging from the classic hyperinsulinemic pattern.
• Understanding this rare subgroup is crucial for accurate diagnosis and management.

Approach:

• A systematic review was conducted on case reports of patients with hypoglycemia and suppressed insulin levels.
• Literature searches were performed across PubMed, Medline, and Embase databases, supplemented by manual citation searches.
• The Joanna Briggs Institute critical appraisal checklist was used to assess bias in the included case reports.

Key Points:

• Eleven case reports met the inclusion criteria, revealing a more diverse patient demographic compared to Type B insulin resistance overall.
• A significant proportion of these cases (3 out of 11) developed lymphoma.
• High-dose corticosteroid therapy demonstrated effectiveness in managing hypoglycemia, often with a rapid response.

Conclusions:

• Isolated hypoglycemia with low insulin represents a rare variant of Type B insulin resistance, lacking typical hyperinsulinemic hypoglycemia and insulin resistance features.
• While autoimmune diseases are common comorbidities, a potential association with aggressive lymphoma, possibly with delayed onset, warrants further investigation.
• This subgroup necessitates distinct clinical consideration due to its unique presentation and potential associations.