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Differential diagnosis of Stiff-person syndrome. Differential diagnosis driven by GAD † autoantibody positivity
Source publication
Stiff-person syndrome (SPS) is highly associated with anti-glutamic acid decarboxylase (GAD) antibody. However, GAD antibodies alone appear to be insufficient to cause SPS, and they possibly are involved in only part of its pathophysiology. It is suspected that the symptoms of SPS get precipitated by external stimuli. Here, we briefly introduce the...
Citations
... Insulin therapy is one of the most important treatments for diabetic patients and plays an important role in the treatment of diabetes mellitus, and it is one of the most used clinical drugs to control blood glucose. 2 Exogenous insulin preparations are widely used in the clinical hypoglycemic treatment of patients with T2DM. 3 However, multiple investigations have demonstrated that since the introduction of insulin therapy, various insulin preparations or analogs as exogenous proteins frequently cause insulin antibodies (IAs) in T2DM patients. [4][5][6] IAs can appear in the body of patients after a period ranging from several weeks to several months of insulin application. 7 While receiving treatment, these antibodies frequently cause glycemic swings and insulin resistance because they irreversibly bind or release insulin in unpredictable ways. ...
Purpose
This study aimed to further quantify the relationship between insulin antibodies (IAs) and the 2-hour insulin to C-peptide molar ratio (2h-ICPR) using a multiple linear regression model in T2DM patients.
Methods
A total of 274 T2DM patients from April 2019 to December 2022 in Xiang’an Hospital of Xiamen University were included in this study. Multiple Linear Model Fitting was conducted on the candidate independent variables (age, BMI, HbA1c, and 2h-ICPR) for the multiple linear regression. The linear relationship between insulin antibodies (IAs) and the significant independent variables was presented by making multiple linear regression equations.
Results
The total demographic characteristics of the included patients were as follows: age (51.92±13.10 years), BMI (24.94±3.99 kg/m²), HbA1c (9.70±2.39%), 2h-ICPR (0.12±0.11), and IAs (0.37±1.12COI). Linear relationships of independent variables: age (r=0.163, p=0.007), 2h-ICPR (r=0.259, p=0.001), BMI (r=0.007, p=0.907) and 2h-ICPR (r=0.092, p=0.129). Multiple linear regression: age (unstandardized β=0.014, 95% CI: 0.004–0.024, p=0.004), 2h-ICPR (unstandardized β=2.758, 95% CI: 1.555–3.962, p≤0.001). The regression equation: $${\rm{IAs = - 0}}{\rm{.712 + 0}}{\rm{.014*age + 2}}{\rm{.758*2h - ICPR(P \lt 0}}{\rm{.001)}}$$.
Conclusion
The quantitative relationship between 2h-ICPR and insulin antibodies was $${\rm{IAs = - 0}}{\rm{.712 + 0}}{\rm{.014*age + 2}}{\rm{.758*2h - ICPR}}$$. 2h-ICPR can be a preliminary screening indicator for insulin antibody testing in patients with type 2 diabetes.
Anti-glutamic acid decarboxylase (GAD) autoantibodies are a hallmark of stiffperson syndrome (SPS) and insulin-dependent diabetes mellitus (IDDM). However, patients with concurrent IDDM and SPS often manifest insulin resistance,
and SPS-associated IDDM probably has heterogeneous causes. Some patients
manifest IDDM associated only with high titers of anti-GAD65 caused by SPS. By
contrast, other patients develop IDDM only after being treated with high-dose
corticosteroids or they progress to insulin dependency following their treatment
with high-dose corticosteroids. The profile of autoantibodies differs markedly
between type 1 diabetes mellitus (T1DM), late-onset diabetes mellitus, and
SPS-associated IDDM. Therefore, as with new-onset diabetes after transplantation (NODAT), SPS-associated IDDM should be classified as a specific diabetes
entity, the pathophysiology of which requires increased attention.
Side Effects of Drugs Annual is an annual publication that publishes side effects, adverse reactions and toxicities associated with medications. The series supplements the contents of Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions. This chapter describes the side effects of insulin and oral hypoglycemic/antihyperglycemic drugs published in scientific journals over the last year (January–December 2020). The overall goal of this chapter is to make healthcare professionals aware of adverse effects associated with drugs used in the treatment of Type 1 and Type 2 diabetes mellitus (DM) and improve management of patients who suffer from adverse effects associated with the use of these drugs.
