A case of slowly progressive type 1 diabetes mellitus with reduced insulin requirement during the administration of disease-modifying anti-rhuematic drugs

Shin Nakamura, Hitoshi Ide, Udai Nakamura, Takanari Kitazono

Research output: Contribution to journalArticle

Abstract

Introduction: This report describes a 53-year-old female with slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) and rheumatoid arthritis (RA) in whom treatment for RA reduced her insulin requirement. Case Description: A routine laboratory examination in March 2004 showed hyperglycemia, which had worsened 5 months later. At this initial examination, her fasting blood glucose and HbAlc levels were 238 mg/dL and 13.1 %, respectively, and she was positive for anti-GAD and anti-IA-2 antibodies. She was diagnosed with SPIDDM and started on insulin therapy, which improved her glycemic control. Following a diagnosis of RA in February 2006, she was started on the immunomodulator leflunomide, which gradually reduced her insulin requirement from 23 U/day to 19 U/day. After starting administration of the tumor necrosis factor (TNF)-alpha inhibitor infliximab in June 2007, she experienced frequent episodes of hypoglycemia. Infliximab was discontinued, and, in December 2008, she started treatment with a combination of methotrexate and leflunomide. She began treatment with adalimumab in April 2015. Her insulin requirement has gradually but progressively decreased to 11 U/day. Her glycemic control remains excellent, with an HbAlc concentration of 5.8 % in August 2015. Conclusion: TNF-alpha inhibitors and/or immunomodulators for RA may preserve the beta cell function, reducing the insulin requirement in patients with SPIDDM.

Original languageEnglish
Pages (from-to)25-29
Number of pages5
JournalJournal of the Japan Diabetes Society
Volume60
Issue number1
Publication statusPublished - Jan 1 2017

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Type 1 Diabetes Mellitus
leflunomide
Insulin
Rheumatoid Arthritis
Pharmaceutical Preparations
Immunologic Factors
Tumor Necrosis Factor-alpha
Therapeutics
Hypoglycemia
Methotrexate
Hyperglycemia
Blood Glucose
Fasting

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

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title = "A case of slowly progressive type 1 diabetes mellitus with reduced insulin requirement during the administration of disease-modifying anti-rhuematic drugs",
abstract = "Introduction: This report describes a 53-year-old female with slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) and rheumatoid arthritis (RA) in whom treatment for RA reduced her insulin requirement. Case Description: A routine laboratory examination in March 2004 showed hyperglycemia, which had worsened 5 months later. At this initial examination, her fasting blood glucose and HbAlc levels were 238 mg/dL and 13.1 {\%}, respectively, and she was positive for anti-GAD and anti-IA-2 antibodies. She was diagnosed with SPIDDM and started on insulin therapy, which improved her glycemic control. Following a diagnosis of RA in February 2006, she was started on the immunomodulator leflunomide, which gradually reduced her insulin requirement from 23 U/day to 19 U/day. After starting administration of the tumor necrosis factor (TNF)-alpha inhibitor infliximab in June 2007, she experienced frequent episodes of hypoglycemia. Infliximab was discontinued, and, in December 2008, she started treatment with a combination of methotrexate and leflunomide. She began treatment with adalimumab in April 2015. Her insulin requirement has gradually but progressively decreased to 11 U/day. Her glycemic control remains excellent, with an HbAlc concentration of 5.8 {\%} in August 2015. Conclusion: TNF-alpha inhibitors and/or immunomodulators for RA may preserve the beta cell function, reducing the insulin requirement in patients with SPIDDM.",
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T1 - A case of slowly progressive type 1 diabetes mellitus with reduced insulin requirement during the administration of disease-modifying anti-rhuematic drugs

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AU - Ide, Hitoshi

AU - Nakamura, Udai

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N2 - Introduction: This report describes a 53-year-old female with slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) and rheumatoid arthritis (RA) in whom treatment for RA reduced her insulin requirement. Case Description: A routine laboratory examination in March 2004 showed hyperglycemia, which had worsened 5 months later. At this initial examination, her fasting blood glucose and HbAlc levels were 238 mg/dL and 13.1 %, respectively, and she was positive for anti-GAD and anti-IA-2 antibodies. She was diagnosed with SPIDDM and started on insulin therapy, which improved her glycemic control. Following a diagnosis of RA in February 2006, she was started on the immunomodulator leflunomide, which gradually reduced her insulin requirement from 23 U/day to 19 U/day. After starting administration of the tumor necrosis factor (TNF)-alpha inhibitor infliximab in June 2007, she experienced frequent episodes of hypoglycemia. Infliximab was discontinued, and, in December 2008, she started treatment with a combination of methotrexate and leflunomide. She began treatment with adalimumab in April 2015. Her insulin requirement has gradually but progressively decreased to 11 U/day. Her glycemic control remains excellent, with an HbAlc concentration of 5.8 % in August 2015. Conclusion: TNF-alpha inhibitors and/or immunomodulators for RA may preserve the beta cell function, reducing the insulin requirement in patients with SPIDDM.

AB - Introduction: This report describes a 53-year-old female with slowly progressive insulin-dependent (type 1) diabetes mellitus (SPIDDM) and rheumatoid arthritis (RA) in whom treatment for RA reduced her insulin requirement. Case Description: A routine laboratory examination in March 2004 showed hyperglycemia, which had worsened 5 months later. At this initial examination, her fasting blood glucose and HbAlc levels were 238 mg/dL and 13.1 %, respectively, and she was positive for anti-GAD and anti-IA-2 antibodies. She was diagnosed with SPIDDM and started on insulin therapy, which improved her glycemic control. Following a diagnosis of RA in February 2006, she was started on the immunomodulator leflunomide, which gradually reduced her insulin requirement from 23 U/day to 19 U/day. After starting administration of the tumor necrosis factor (TNF)-alpha inhibitor infliximab in June 2007, she experienced frequent episodes of hypoglycemia. Infliximab was discontinued, and, in December 2008, she started treatment with a combination of methotrexate and leflunomide. She began treatment with adalimumab in April 2015. Her insulin requirement has gradually but progressively decreased to 11 U/day. Her glycemic control remains excellent, with an HbAlc concentration of 5.8 % in August 2015. Conclusion: TNF-alpha inhibitors and/or immunomodulators for RA may preserve the beta cell function, reducing the insulin requirement in patients with SPIDDM.

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