Insulin Glargine Induces Less Insulin Antibody Than Other Insulin Regimens
Insulin antibodies (IAs), which were found commonly developed in patients treated with exogenous insulin, might affect glycemic control due to their tendency to bind and/or release insulin in an unpredictable fashion.
A recent study suggests that positive IAs was significantly lower in patients using insulin glargine compared with the other insulin therapy regimens, while DPP-4 inhibitors, metformin, and insulin secretagogues may also have potential effects on reducing IA levels.
The study findings were published in the Research Square as a preprint on February 23, 2022.
Along with the development of recombinant human insulin and insulin analogues, several studies found that circulating IA levels is closely related to the mode of insulin injection and the types of insulin. However, previous studies usually compared IA levels between patients using two types of insulin that act similarly. The different effects of all the types of insulin currently being used, as well as oral glucose-lowering drugs on IA, remain understudied. Therefore, researchers of the Nanjing First Hospital conducted a study to investigate the association between different glucose-lowering treatments and IAs in patients with type 2 Diabetic Mellitus (T2DM).
In this cross-sectional, retrospective study, the researchers included 1863 patients with T2DM who were using exogenous insulin therapy. They included patients who had stable antidiabetic therapy in the last 3 months and measured IA levels using the iodine-125 array. Among 1863 patients, 902 (48.4%) patients had positive IAs (IA level >5%).
Key findings of the study:
- Upon analysis, the researchers found that IA level was positively correlated with fasting blood glucose (OR=1.069).
- They also found that the proportion of positive IAs was lowest in patients using glargine only (31.9%) and highest in patients using human insulin only (70.3%).
- They noted that the IA levels in patients using sulfonylureas/glinides (8.3 %), metformin (9.6 %), and DPP-4 inhibitors (8.2 %) were all lower than in patients without these drugs.
The authors concluded, "IA levels should be tested in patients with T2DM who are using insulin therapy, especially in elderly non-smokers with lipid metabolic disorder. The use of insulin glargine, DPP-4 inhibitors, metformin, insulin secretagogues, and SGLT2 inhibitors were associated with lower IA levels, which may be considered in patients with T2DM who need insulin therapy, especially those who had positive IAs. The causal relationships between changes of IA levels and these drugs need further study."
For further information:
DOI:10.21203/rs.3.rs-1345032/v1
Keywords:
insulin antibodies, insulin therapy, glucose-lowering drugs, glargine, DPP-4 inhibitors, metformin, insulin secretagogues, SGLT2 inhibitors, type 2 diabetic mellitus, Research Square, Peng Zhang
