Insulin analogues as a new example of interference in insulin assays

Ismail, A. A. A.

doi:10.1177/0004563215590165

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Therefore, we administered IVIG after the TPE procedures, and IVIG reduced the daily insulin dosage slightly. It is important to consider the unpredictability and potential inaccuracy of insulin measurements in this case, secondary to endogenous IAs, which are known to interfere and cross‐react in immunoassays 19 . Therefore, we decided to evaluate the effect of treatment by daily insulin dosage and the patient's glycemic profile.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to consider the unpredictability and potential inaccuracy of insulin measurements in this case, secondary to endogenous IAs, which are known to interfere and cross‐react in immunoassays. 19 Therefore, we decided to evaluate the effect of treatment by daily insulin dosage and the patient's glycemic profile. TPE was the most important therapeutic strategy that played a key role in the treatment of this patient, although the cumulative effect of methylprednisolone in the later stage should not be ruled out.…”

Section: Discussionmentioning

confidence: 99%

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Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy

Zhuang

Wei

2021

J of Clinical Apheresis

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A 43‐year‐old man with a 23‐year history of type II diabetes presented with uncontrolled hyperglycemia with frequent episodes of ketoacidosis. He was diagnosed with exogenous insulin antibody syndrome, and received high‐dose methylprednisolone to treat insulin resistance. Ketoacidosis relapsed 2 years later, and the patient showed an incomplete response to glucocorticoids. We decided to administer therapeutic plasma exchange, which resulted in rapid lowering of the daily insulin requirement and improved glycemic control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy

Zhuang

Wei

2021

J of Clinical Apheresis

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“…The underlying pathology is elevated insulin autoantibody (IAA) titres without pancreatic islet abnormalities 2 . Patients are not diabetic and have no prior exposure to exogenous insulin or insulin analogs, which are known to produce insulin antibodies in some patients 3,4 . The incidence of IAS is higher in Asian populations than in Caucasian populations, 5,6 but its morbidity in both populations is unclear.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Analysis of the clinical characteristics of insulin autoimmune syndrome induced by methimazole

et al. 2020

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What is known and Objective The number of case reports of insulin autoimmune syndrome (IAS) induced by methimazole (MMI) is increasing. The purpose of this study is to explore the clinical characteristics and provide a scientific reference for clinical diagnosis, treatment and prevention. Methods The literature on IAS cases and case series induced by MMI in Chinese and English was collected for retrospective analysis. Results and discussion A total of 106 patients (males 33, females 73) were described in the Chinese and English literature. The median age of patients with IAS induced by MMI was 37 years (range 15‐76) occurring during both regular and irregular MMI therapy or after resumption of medication. The onset of symptoms occurred at night or early morning, within days in some and up to 6 months in others; the symptoms were neuropathic in 65.31% and related to the autonomic nervous system in 33.67%. Blood glucose concentration in samples presumably taken during the hypoglycaemic phase was 1.7 mmol/L (median; range 0.03‐4.7); insulin concentrations were elevated ≥100 mU/L (ref range) and associated with low C‐peptide levels (<10 μg/L; ref range). Tests for IgG insulin autoantibodies (IAA) were positive in 104 patients (98.02%) and negative in two patients (1.98%). The 75‐g oral glucose tolerance test (OGTT) showed impaired glucose tolerance and diabetic curves. Pancreatic imaging was unremarkable on computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Withdrawal of MMI alone or with corticosteroid treatment reduced hypoglycaemic episodes within days to 3 months. IAA decreased and became negative in 3 months (median; range 1‐12). Follow‐up showed no recurrent hypoglycaemic episodes at 5 months (median; range 1‐60). What is new and Conclusion Methimazole‐induced IAS is a clinically rare autoimmune disease with hypoglycaemia that occurs during medication treatment that should be treated promptly.

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“…Potential misdiagnosis is therefore likely to occur if these two interdependent entities namely the presence and nature of endogenous antibodies and immunoassays cross-reactivities are not considered and taken into account. Finally, the term IAS must not be confused with the effect of endogenous insulin antibodies in patients with brittle diabetes triggered by exogenous administration of insulin or insulin analogues causing poor glycaemic control and hypoglycaemia by a mechanism similar to IAS [100][101][102][103].…”

Section: Comments and Conclusionmentioning

confidence: 99%

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

Ismail¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Insulin autoimmune syndrome (IAS) is considered to be very rare in Caucasians. Understanding its pathophysiology is paramount in (a) appreciating its potential impact on analyses of pancreatic hormones and (b) explaining its highly variable clinical manifestations in non-diabetic, non-acutely ill patients with indeterminate hypoglycaemia. The underlying aetiology of IAS is the presence of variable affinity/avidity endogenous insulin antibodies in significant amounts. The two types of insulin antibodies namely antibodies which bind insulin and/ or proinsulin(s) and receptor antibodies (insulin mimetic) will be discussed. Their biochemical and immunological roles in causing hypoglycaemia will be highlighted. Clinical manifestations of IAS can vary from mild and transient to spontaneous, severe and protracted hypoglycaemia necessitating in extreme cases plasmapheresis for glycaemic control. Antibodies of IAS can interfere in pancreatic immunoassay tests causing erroneous and potentially misleading results. Thorough testing for endogenous insulin antibodies must be considered in the investigations of non-diabetic, non-acutely ill patients with indeterminate and/or unexplained hypoglycaemia.Keywords: endogenous insulin antibodies; Hirata's disease, insulin autoimmune hypoglycaemia; hypoglycaemia in non-diabetic; insulin autoimmune syndrome (IAS); interference in immunoassays of insulin, proinsulin and C-peptide; wrong immunoassay results .

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Insulin analogues as a new example of interference in insulin assays

Cited by 4 publications

References 9 publications

Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy

Exogenous insulin antibody syndrome treated with plasma exchange after an incomplete response to immunosuppressive therapy

Analysis of the clinical characteristics of insulin autoimmune syndrome induced by methimazole

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

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