Kyrstin L Lane1,2, Tannaz Moin1,3. 1. Division of Endocrinology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California. 2. VA Greater Los Angeles Healthcare System, Los Angeles, California. 3. Health Services Research and Development, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California.
Abstract
OBJECTIVE: Diabetes that develops in human immunodeficiency virus-infected individuals is typically classified as type 2 diabetes mellitus. Although less commonly reported, it has been shown that autoimmune diabetes can also develop in this population. METHODS: We present a case of a patient found to have autoimmune diabetes following initiation of anti-retroviral therapy. RESULTS: A 68-year-old, African American man with human immunodeficiency virus had a nadir CD4 count of 2 cells/μL, which improved with anti-retroviral therapy. He was subsequently diagnosed with type 2 diabetes mellitus but developed worsening glycemic control. Further investigation demonstrated an elevated glutamic acid decarboxylase antibody level >250 IU/mL and a declining C peptide level from 1.82 ng/mL to 0.56 ng/mL. He was ultimately diagnosed with autoimmune diabetes that was treated with insulin glargine and insulin aspart with improvement in his glycemic control. CONCLUSION: Autoimmune diabetes in this case was attributed to immune reconstitution after anti-retroviral therapy led to recovery from a significantly low CD4 count. While this phenomenon has been described in previous case reports, our case was unique in that autoimmune diabetes affected an older African American man, a different demographic than previously reported. Although the true mechanism of this association remains unknown, the recognition of autoimmune diabetes is crucial as it greatly impacts diabetes management.
OBJECTIVE: Diabetes that develops in human immunodeficiency virus-infected individuals is typically classified as type 2 diabetes mellitus. Although less commonly reported, it has been shown that autoimmune diabetes can also develop in this population. METHODS: We present a case of a patient found to have autoimmune diabetes following initiation of anti-retroviral therapy. RESULTS: A 68-year-old, African American man with human immunodeficiency virus had a nadir CD4 count of 2 cells/μL, which improved with anti-retroviral therapy. He was subsequently diagnosed with type 2 diabetes mellitus but developed worsening glycemic control. Further investigation demonstrated an elevated glutamic acid decarboxylase antibody level >250 IU/mL and a declining C peptide level from 1.82 ng/mL to 0.56 ng/mL. He was ultimately diagnosed with autoimmune diabetes that was treated with insulin glargine and insulin aspart with improvement in his glycemic control. CONCLUSION: Autoimmune diabetes in this case was attributed to immune reconstitution after anti-retroviral therapy led to recovery from a significantly low CD4 count. While this phenomenon has been described in previous case reports, our case was unique in that autoimmune diabetes affected an older African American man, a different demographic than previously reported. Although the true mechanism of this association remains unknown, the recognition of autoimmune diabetes is crucial as it greatly impacts diabetes management.
Authors: Asa K Davis; Stephanie N DuBose; Michael J Haller; Kellee M Miller; Linda A DiMeglio; Kathleen E Bethin; Robin S Goland; Ellen M Greenberg; David R Liljenquist; Andrew J Ahmann; Santica M Marcovina; Anne L Peters; Roy W Beck; Carla J Greenbaum Journal: Diabetes Care Date: 2014-12-17 Impact factor: 19.112