Analysis Of Clinical Characteristics Of Diabetic Patients With Positive Exogenous Insulin Antibody

Background:Diabetes mellitus?DM?is a public health problem.Due to population growth,aging,urbanization,obesity and lack of physical exercise,the global prevalence rate is gradually increasing.The World Health Organization?WHO?has made a prediction that the average prevalence of diabetes in all age groups of the world in 2000 is as high as 2.8%,and it is expected to reach 4.4%in 2030.Diabetes and its complications not only affect the quality of life of patients,but also bring a heavy economic burden to families,society and the country^[1].Insulin therapy has become a common treatment for d iabetes.However,some studies have found that after several weeks to several months of insulin treatment,exogenous insulin antibodies can appear in the body and the immune phenomena associated with insulin antibodies can be observed.The emergence of ins ulin antibody brings many challenges to the clinical treatment of diabetes patients.Objective:This paper analyzed the multiple related factors and independent risk factors that lead to the positive of exogenous insulin antibody in patients with diabetes mellitus.At the same time,patients in the antibody positive group were divided into subgroups according to the titer of insulin antibody,and the differences in clinical indicators among every subgroup were analyzed.Through analysis,we obtained the ind ex that can predict antibody positivity.The purpose of the paper is to improve the clinical doctors'understanding of exogenous insulin antibody syndrome?EIAS?and guide clinical diagnosis and treatment.Methods:This study selected the patients in the Department of Endocrinology of the second department of Bethune first Hospital of Jilin University from July 1,2019 to January 20,2020,which met the diagnostic criteria of diabetes mellitus and were treated with insulin.116 patients with insulin antibody positive in fasting venous blood were selected as the observation group,while 121 patients with insulin antibody negative in the same period were selected as the control group.The insulin antibody positive group was divided into four subgroups according to antibody titer four-position method for inter-group analysis.We collected the general information and clinical data of the above patients,the general information includes:gender,age,type of diabetes,duration of diabetes,body mass index?BMI?,dura tion of medication?insulin?,Insulin dosage and insulin type;biochemical indicators?all fasting blood collection?include fasting blood glucose,insulin,C peptide,insulin antibody?IA?,glycosylated hemoglobin?glycosylated hemoglobin,HbA1c?,liver function,kidney function,thyroid function,blood lipid and other indexes.The original data tables were made by WPS-Excel software,and the data was described and analyzed by SPSS25.0 and STATA15.0 software.The inspection level of the analysis was 0.05.Results:1.The proportion of female patients in the insulin antibody positive group was higher than that in the negative group;the proportion of patients using premixed human insulin and premixed aspart insulin in the insulin antibody positive group was higher than that in the negative group.2.The levels of fasting insulin,fas ting insulin/C peptide,insulin resistance index,glycosylated hemoglobin,lipoprotein a and retinol binding protein in the insulin antibody positive group were higher than those in the negative group,and the levels of FT₃ and triglyceride were lower tha n those in the negative group.3.Fasting c-peptide and cystatin C were protective factors of insulin antibody.Fasting insulin,glycosylated hemoglobin,and retinol binding proteins were risk factors for insulin antibody positiity.4.As a predictor of positive insulin antibody,the sensitivity and specificity of the insulin/C peptide ratio were 0.793 and0.471,respectively.When the jorden index is at its maximum,the critical value of the corresponding ratio is 9.68.As a predictor,the sensitivity and specificity of the insulin resistance index were0.466 and 0.711,respectively.When the jorden index is at its maximum,the corresponding critical value of insulin resistance index is 8.80.As a predictor,the sensitivity and specificity of the insulin resistance index were 0.793 and 0.347,respectively.When the jorden index is at its maximum,the corresponding critical value is 24.5mg/L.5.The subgroup analysis showed that the higher the insulin resistance index was,the lower the BMI was,and the higher the antibody titer was.The minimum titer of insulin antibody was1.10 COI in the antibody positive cases included in the study,and the corresponding insulin resistance index and BMI were 3.30and 26.20,respectively.The maximum titer of antibody was99.70 COI,and the corresponding insulin resistance index and BMI were 10.44 and 24.60,respectively.Antibody titers of patients treated with premixed aspart insulin and the combination of short-acting and long-acting insulin were higher than those treated with premixed human insulin.Conclusion:1.Patients with positive insulin antibody had higher levels of fasting insulin,insulin/C peptide,glycosylated hemoglobin,and retinol binding protein.2.The severity of insulin antibody titer was correlated with insulin resistance index and BMI.High insulin resistance and low BMI in patients may indicate insulin antibody positivity.3.Insulin/C peptide ratio,insulin resistance index and retinol binding protein all have certain diagnostic value for insulin antibody positive.The reference thresholds of insulin/C peptide ratio,insulin resistance index and retinol binding protein were 9.68,8.80 and 24.5mg/L,respectively.4.Antibody titers of patients who received premixed a-spart insulin and in combination with short-acting and long-acting insulin were higher than those who received premix ed human insulin.