Nishimura Akihiro, Nagasawa Kaoru, Okubo Minoru, Kobayashi Tetsuro, Mori Yasumichi
Department of Endocrinology and Metabolism Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan.
Endocr J. 2015;62(12):1077-82. doi: 10.1507/endocrj.EJ15-0378. Epub 2015 Oct 3.
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: DRB104:05-DQB104:01. 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.
很少有文章描述过缓慢进展型1型糖尿病（SPIDDM）确诊后谷氨酸脱羧酶抗体（GADAb）水平的波动情况。在此，我们报告一例在开始和停止胰岛素治疗后GADAb水平呈指数级升高的病例。一名新诊断为SPIDDM的64岁女性患者入院并开始每日多次注射胰岛素。患者的GADAb滴度为6.9 U/mL（正常：<1.4 U/mL），且患者具有在日本人群中已知的1型糖尿病易感HLA II类单倍型：DRB104:05 - DQB104:01。当患者进入“蜜月期”时，观察到低血糖，胰岛素剂量减少。诊断后两个月，患者每天注射1单位甘精胰岛素，血糖控制良好。随后，患者的家庭医生建议停止胰岛素注射。诊断后三个月，患者的GADAb滴度突然升至1600 U/mL。诊断后36个月，患者的GADAb滴度下降但仍为阳性（40 U/mL）。糖化血红蛋白（HbA1c）水平维持在7%以下，诊断后10、26和36个月的口服葡萄糖耐量试验表明患者保留了胰岛素分泌功能。据我们所知，这是第一份描述SPIDDM患者在开始和停止胰岛素治疗后GADAb呈指数级升高的报告。
