Clinical Features of Type B Insulin Resistance in Japanese Patients: Case Report and Survey-Based Case Series Study.

Type B insulin resistance (TBIR) is an extremely rare disease characterized by marked hyperglycemia and insulin resistance and often coexists with autoimmune diseases. The characteristics, symptoms, blood glucose patterns, comorbidities, and treatments of TBIR all vary and are not defined. In this study, we described a case of TBIR that developed 6 months after DPP-4 inhibitor administration and immediately after the patient caught a cold. Treatment using prednisolone and insulin-like growth factor-1 was effective. We also conducted an observational survey-based case series study in a Japanese cohort comprising 21 cases. The average age of onset of TBIR was 62.3 ± 14.8 (17-84) years, and 61.9% of subjects were male. The majority of patients (90.4%) were 50 years old and over. During the study period, there was a high percentage (85.7%) of episodes of hypoglycemia, which was the trigger for diagnosis in more than 50% of cases. Glycemic patterns included 7 cases of hyperglycemia (33.3%), 10 cases of hypoglycemia (47.6%), and 4 cases of both hyperglycemia and hypoglycemia (19.1%). In the hypoglycemic group, 90.0% of patients were male. Furthermore, 71.4% of cases were antinuclear antibody positive, and 81.0% of cases were complicated with autoimmune disease. Systemic lupus erythematosus (38.1%) and Sjögren's syndrome (23.8%) were relatively common as coexisting autoimmune diseases. Treatment was based on prednisolone use, which was used in 88.9% of patients. On the other hand, the effect of IGF-1 was limited. Overall, the prognosis of TBIR was good.

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Copyright © 2020 Yusuke Hirota et al.

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Dr. Kadowaki reports personal fees from Abbott; personal fees and endowed chair from Asahi Mutual Life Insurance; grants and personal fees from Astellas Pharma Inc.; personal fees and contracted research from AstraZeneca K.K.; personal fees from Bayer; personal fees and endowed chair from Boehringer Ingelheim; personal fees from Cosmic; grants, personal fees, joint research, and clinical trial from Daiichi Sankyo Company, Limited; grants and personal fees from Eli Lilly and Company; personal fees from Fujifilm; personal fees from Fujirebio; personal fees from Johnson & Johnson Co., Ltd.; grants and personal fees from Kissei Pharmaceutical Co., Ltd.; personal fees and endowed chair from Kowa Co., Ltd.; personal fees from Kyowa Hakko Kirin Co., Ltd.; personal fees from Medical Review; personal fees from Medscape Education; personal fees from Medtronic Sofamor Danek; grants, personal fees, and endowed chair from Mitsubishi Tanabe Pharma Corporation; grants, personal fees, and endowed chair from MSD; personal fees from Musashino Foods; personal fees from Nipro; personal fees from Novartis International AG; grants, personal fees, and endowed chair from Novo Nordisk Pharma Ltd.; grants, personal fees, and endowed chair from Ono Pharmaceutical Co., Ltd.; grants and personal fees from Sanofi S.A.; personal fees from Sanwa Kagaku Kenkyusho Co., Ltd.; grants and personal fees from Sumitomo Dainippon; grants and personal fees from Taisho Pharmaceutical Co., Ltd.; grants, personal fees, endowed chair, and contracted research from Takeda Pharmaceutical Company Limited; and personal fees from Terumo while performing the study and outside the submitted work. Dr. Yamauchi reports personal fees from Johnson & Johnson Co., Ltd.; grants and personal fees from Mitsubishi Tanabe Pharma Corporation; personal fees from Covidien Japan Inc. (Medtronic Japan Co., Ltd.); grants and personal fees from Takeda Pharmaceutical Company Limited; grants and personal fees from Novo Nordisk Pharma Ltd.; grants and personal fees from Astellas Pharma Inc.; grants and personal fees from AstraZeneca K.K.; grants and personal fees from Ono Pharmaceutical Co., Ltd.; grants and personal fees from Novartis International AG; grants and personal fees from Boehringer Ingelheim GmbH Japan; grants and personal fees from Kyowa Kirin Co., Ltd.; grants and personal fees from Kowa Pharmaceutical Company, Ltd.; grants and personal fees from Merck Sharp & Dohme Co. (Merck & Co.); grants and personal fees from Sanofi S.A.; personal fees from Sanwa Kagaku Kenkyusho Co., Ltd.; grants and personal fees from Shionogi & Co., Ltd.; grants and personal fees from Daiichi Sankyo Company, Limited; personal fees from Taisho Pharmaceutical Co., Ltd.; grants from Tosoh Corporation; personal fees from Eli Lilly and Company; personal fees from Kissei Pharmaceutical Co., Ltd.; grants and personal fees from Sanwa Chemistry Laboratory Co., Ltd.; personal fees from Sumitomo Dainippon Pharma Co., Ltd.; grants from NTT Docomo, Inc.; grants from Mitsubishi Corporation Life Sciences Limited; and grants from AeroSwitch while performing the study and outside the submitted work; personal fees from Johnson & Johnson Co., Ltd.; grants and personal fees from Mitsubishi Tanabe Pharma Corporation; personal fees from Covidien Japan Inc. (Medtronic Japan Co., Ltd.); grants and personal fees from Takeda Pharmaceutical Company Limited; grants and personal fees from Novo Nordisk Pharma Ltd.; grants and personal fees from Astellas Pharma Inc.; grants and personal fees from AstraZeneca K.K.; grants and personal fees from Ono Pharmaceutical Co., Ltd.; grants and personal fees from Novartis International AG; grants and personal fees from Boehringer Ingelheim GmbH Japan; grants and personal fees from Kyowa Kirin Co., Ltd.; grants and personal fees from Kowa Pharmaceutical Company, Ltd.; grants and personal fees from Merck Sharp & Dohme Co. (Merck & Co.); grants and personal fees from Sanofi S.A.; personal fees from Sanwa Kagaku Kenkyusho Co., Ltd.; grants and personal fees from Shionogi & Co., Ltd.; grants and personal fees from Daiichi Sankyo Company, Limited; personal fees from Taisho Pharmaceutical Co., Ltd.; grants from Tosoh Corporation; personal fees from Eli Lilly and Company; personal fees from Kissei Pharmaceutical Co., Ltd.; grants and personal fees from Sanwa Chemistry Laboratory Co., Ltd.; personal fees from Sumitomo Dainippon Pharma Co., Ltd.; grants from NTT Docomo, Inc.; grants from Mitsubishi Corporation Life Sciences Limited; and grants from AeroSwitch, outside the submitted work. Dr. Suwanai reports commissioned research from Astellas Pharma Inc., outside the submitted work. Dr. Hirota has no conflicts of interest.