Exponential increase of glutamic acid decarboxylase (GAD) antibody titer after initiating and stopping insulin in a patient with slowly progressive type 1 diabetes

Endocrine Journal

Tetsuro Kobayashi²  Yasumichi Mori¹  Akihiro Nishimura¹  Minoru Okubo¹  Kaoru Nagasawa¹ 

[1] Department of Endocrinology and Metabolism Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan;Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan

关键词: Slowly progressive type 1 diabetes (SPIDDM);    Latent autoimmune diabetes in adults (LADA);    Glutamic acid decarboxylase (GAD) antibody;    Insulin therapy;   

DOI  :  10.1507/endocrj.EJ15-0378

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(27)Cited-By(1)Few articles have described fluctuations in glutamic acid decarboxylase antibody (GADAb) levels after a diagnosis of slowly progressive type 1 diabetes (SPIDDM).Here, we present a case in which GADAb levels exponentially increased after initiating and stopping insulin.A 64-year-old female patient newly diagnosed with SPIDDM was admitted and started multiple daily insulin injections.The patient’s GADAb titer was 6.9 U/mL (normal: <1.4 U/mL) and the patient had a type 1 diabetes susceptible HLA class II haplotype known in the Japanese population as: DRB1*04:05-DQB1*04:01.When the patient’s “honeymoon period” set in, hypoglycemia was observed and the dose of insulin was reduced.Two months after the diagnosis, 1 unit of insulin glargine/day was being injected and the patient demonstrated good glycemic control.Subsequently, the patient’s home doctor recommended that insulin injections be stopped.Three months after the diagnosis, the patient’s GADAb titer suddenly increased to 1600 U/mL.The patient’s GADAb titer decreased but was still positive (40 U/mL) 36 months after diagnosis.HbA1c levels were maintained below 7%, and oral glucose tolerance tests at 10, 26, and 36 months after diagnosis suggested that the patient had preserved insulin secretion.To the best of our knowledge, this is the first report that describes exponential increases in GADAb after initiating and stopping insulin in a patient with SPIDDM.

【 授权许可】

Unknown