Suehiro Tadashi, Osaki Fumiaki, Ikeda Yukio, Arii Kaoru, Nakayama Fumi, Ota Kikuko, Hashimoto Kozo
Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan.
Diabetes Res Clin Pract. 2005 Dec;70(3):298-302. doi: 10.1016/j.diabres.2005.04.007. Epub 2005 Jun 13.
We report a 38-year-old female with severe insulin resistance who developed type 1 diabetes after being diagnosed with type 2 diabetes. At the initial examination, BMI was 31.8 kg/m(2) and HbA1c 10.8%. Her insulin secretion was sufficient (urinary CPR 80 microg/day) and the GAD antibody was negative. Following treatment with insulin and glimepiride, HbA1c decreased to 6.3%, though diabetic control deteriorated after 1 year (HbA1c, 11.0%) and her body weight was reduced in a short period, from 78 to 67 kg. Re-examination revealed that the GAD antibody was high (1870 U/mL, normal <1.5) and the anti-islet cell antibody positive, and insulin secretion decreased (urinary CPR 18 microg/day). Further, a hyperinsulinemic-euglycemic cramp study using an artificial pancreas showed that the patient had severe insulin resistance [glucose infusion rate 1.8 mg/(min kg); normal, 7.4+/-2.4 (mean+/-S.D.)]. An HLA-analysis showed that she was a homozygote of haplotype DRB10901-DQB10303. In spite of strict insulin therapy, glucose control was not improved. Pioglitazone could not be used because of side effects, however, metformin was effective for glucose control. The accumulation of case reports of patients with type 1 diabetes and insulin resistance is important for studying the relationship between the onset of the disease and insulin resistance, and for developing an effective treatment strategy.
我们报告了一名38岁的严重胰岛素抵抗女性，她在被诊断为2型糖尿病后发展为1型糖尿病。初诊时，体重指数（BMI）为31.8kg/m²，糖化血红蛋白（HbA1c）为10.8%。她的胰岛素分泌充足（尿C肽释放率80μg/天），谷氨酸脱羧酶（GAD）抗体阴性。接受胰岛素和格列美脲治疗后，HbA1c降至6.3%，但1年后糖尿病控制情况恶化（HbA1c为11.0%），且她的体重在短期内从78kg降至67kg。复查发现GAD抗体升高（1870U/mL，正常<1.5），抗胰岛细胞抗体阳性，胰岛素分泌减少（尿C肽释放率18μg/天）。此外，使用人工胰腺进行的高胰岛素-正葡萄糖钳夹试验显示，该患者存在严重的胰岛素抵抗[葡萄糖输注速率1.8mg/（min·kg）；正常为7.4±2.4（均值±标准差）]。一项人类白细胞抗原（HLA）分析显示，她是单倍型DRB10901-DQB10303的纯合子。尽管进行了严格的胰岛素治疗，但血糖控制仍未改善。由于副作用，无法使用吡格列酮，不过二甲双胍对血糖控制有效。1型糖尿病合并胰岛素抵抗患者病例报告的积累，对于研究疾病发病与胰岛素抵抗之间的关系以及制定有效的治疗策略具有重要意义。
