engleski

Severe lipoatrophy in a patient with type 2 diabetes in response to human insulin analogs glargine and degludec: possible involvement of CD4 T cell–mediated tissue remodeling

A female patient age 69 years with .10-year history of type 2 diabetes (T2D), on a therapy of premixed aspart insulin, presented with poor glycemic control (HbA1c 8.7%). Change of therapy to three injections of short- acting aspart and once-daily glargine improved glycemic control but resulted in severe lipoatrophy at all sites of injection, a rare complication of insulin therapy almost exclusively associated with type 1 diabetes (T1D). The patient had C-peptide levels within normal range and lacked autoantibodies against GAD, islet antigen 2 (IA-2), and tissue transglutaminase (tTg), excluding T1D. Glargine injection was replaced by degludec, but this did not prevent formation of new indentures. Histological analysis of tissue biopsies revealed strong tissue remodeling at affected sites including fibrosis, reduction of adipocyte size, and increased vascularization. Immunohistochemical staining showed a strong influx of CD4 T cells in affected sites but no apparent signs of T cell–mediated cell death. Flow cytometry of peripheral blood leukocytes did not show an overt effector cell profile of CD4 T cells, indicating that the response was mediated locally. Our findings indicate that insulin-induced lipoatrophy in the context of T2D is distinct from that seen in T1D and appears to depend on CD4 T cell–mediated tissue remodeling.

lipoatrophy ; type 2 diabetes ; human insulin

nije evidentirano