From the Guidelines
Positive insulin autoantibodies (IAA) can indeed affect the efficacy of insulin injections, leading to insulin resistance and requiring higher doses to achieve adequate glycemic control. The presence of IAA can neutralize injected insulin molecules, reducing their glucose-lowering effects [ 1 ]. This phenomenon is more common in patients using animal-derived insulins, those with certain autoimmune conditions, or individuals with genetic predispositions to autoimmunity [ 1 ]. Management strategies for patients with IAA include switching to different insulin formulations, such as changing from human insulin to insulin analogs like glargine or lispro, adding immunosuppressive therapy like prednisone, or using non-insulin diabetes medications when possible [ 1 ]. Blood tests measuring insulin antibody titers can confirm this diagnosis in patients experiencing unexplained insulin resistance [ 1 ]. Key considerations in managing type 1 diabetes include the use of basal insulin, mealtime insulin, and correction insulin, as well as the potential benefits of continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems [ 1 ]. Ultimately, the goal of treatment is to prevent diabetic ketoacidosis, minimize clinically relevant hypoglycemia, and achieve individualized glycemic goals while considering factors such as cost, patient preferences, and self-management capabilities [ 1 ]. Some important points to consider when choosing among insulin delivery systems include:
- Individual preferences
- Cost
- Insulin type
- Dosing plan
- Self-management capabilities It is essential to reassess insulin-taking behavior and adjust treatment plans regularly to account for specific factors that impact choice of treatment [ 1 ].
From the Research
Effect of Positive Insulin Autoantibodies (IAA) on Insulin Injections
- The presence of insulin autoantibodies (IAA) can affect the efficacy of insulin injections, as they can bind to insulin and potentially alter its absorption and action 2.
- Studies have shown that patients with IAA at diagnosis develop higher insulin antibody measurements when subsequently treated with exogenous insulin, which can lead to increased insulin binding and potentially affect glucose control 2, 3.
- However, the development of IAs does not necessarily impair glycaemic control, as seen in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDI) therapy 3.
Mechanisms and Implications
- The exact mechanisms by which IAA affect insulin injections are not fully understood, but it is thought that the binding of IAA to insulin can lead to increased insulin antibody measurements and potentially alter the pharmacokinetics and pharmacodynamics of insulin 2, 4.
- The presence of IAA can also be a marker for autoimmune diabetes, and the determination of IAA, along with other autoantibodies, can improve the prediction of early insulin requirement in adult-onset autoimmune diabetes 5.
- Further research is needed to fully understand the implications of IAA on insulin therapy and to determine the optimal treatment strategies for patients with positive IAA 6, 3.
Clinical Relevance
- The presence of IAA should be considered in patients with diabetes who are receiving insulin therapy, as it can potentially affect the efficacy of treatment 2, 3.
- Clinicians should be aware of the potential for IAA to bind to insulin and alter its action, and should monitor patients closely for signs of impaired glucose control or hypoglycaemia 4, 3.
- Further studies are needed to determine the clinical relevance of IAA in different patient populations and to develop evidence-based guidelines for the management of patients with positive IAA 6, 5.