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Rheumatologic Manifestations of Patients With Type B Insulin Resistance.

S Amara Ogbonnaya1, Sandra G Williams1, Raphael A Kirou1

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Type B insulin resistance (TBIR), a rare complication of systemic lupus erythematosus (SLE), is linked to high U1RNP autoantibodies. Early recognition and treatment are crucial for this life-threatening condition.

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Area of Science:

  • Endocrinology
  • Rheumatology
  • Immunology

Background:

  • Type B insulin resistance (TBIR) is an autoimmune condition caused by autoantibodies inhibiting the insulin receptor.
  • It often presents with severe hyperglycemia, weight loss, and acanthosis nigricans, requiring intensive insulin therapy and carrying a high mortality rate without treatment.
  • TBIR is frequently associated with systemic lupus erythematosus (SLE).

Purpose of the Study:

  • To identify clinical and laboratory features associated with TBIR in patients.
  • To raise awareness of TBIR as a rare but life-threatening condition, often linked to SLE.

Main Methods:

  • Retrospective chart review of 38 patients with TBIR seen at the National Institutes of Health (1976-2024).
  • Analysis included primary rheumatologic diagnoses, endocrinologic laboratory measurements, and SLE manifestations (hypocomplementemia, cytopenias, autoantibodies).

Main Results:

  • Systemic lupus erythematosus (SLE) was the most frequent underlying diagnosis (81.5%).
  • Patients were predominantly female (89.5%) and Black/African American (84.2%), with a median SLEDAI-2K score of 14.
  • High titer U1RNP autoantibodies were present in over 50% of patients. Associated conditions included cranial nerve neuropathies (18.4%), angioedema (10.5%), and uveitis (5%).

Conclusions:

  • Type B insulin resistance (TBIR) is a rare but serious complication of SLE.
  • High titer U1RNP autoantibodies are associated with TBIR in SLE patients.
  • TBIR may co-occur with other rare SLE manifestations, highlighting the need for comprehensive patient evaluation.