Association between glucose-lowering drugs and circulating insulin antibodies induced by exogenous insulin therapy in patients with type 2 diabetes

Abstract Aim: Insulin antibodies (IAs) affects blood glucose control in patients using insulin therapy. We aim to investigate the association between different glucose-lowering treatments and IAs in patients with type 2 diabetic mellitus (T2DM).Methods: In this cross-sectional, retrospective study, patients with T2DM who were using exogenous insulin therapy were included. All the patients had stable antidiabetic therapy in the last 3 months and measured IA levels using the iodine-125 array. Results: A total of 1863 patients were enrolled. There were 902 (48.4%) patients with positive IAs (IA level >5%), and the mean IA level was 11.06 (10.39, 11.72) %. IA level was positively correlated with fasting blood glucose (OR=1.069, p<0.001). The proportion of positive IAs was lowest in patients using glargine only (31.9%) and highest in patients using human insulin only (70.3%), p<0.001. 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 (p all <0.05).Conclusions: IA levels should be measured in patients with long-term insulin therapy. Insulin glargine and the combination of oral glucose-lowering drugs should be considered in IA positive patients.