{"title":"Case Report: Insulin resistance in type 1 diabetes mellitus: the role of genetic factors.","authors":"Jintao Wei, Shi-Yuan Lu, Tianyue Zhang","doi":"10.3389/fendo.2025.1656453","DOIUrl":null,"url":null,"abstract":"<p><p>We report a 52-year-old man with autoantibody-negative type 1 diabetes (T1D) who presented with severe insulin resistance (IR). Whole-exome sequencing (WES) identified a heterozygous mutation in the IGF2BP2 gene (c.248A>G, p. Lys83Thr; rs4402960), associated with type 2 diabetes (T2D) risk. Despite intensive insulin therapy, the patient exhibited markedly elevated insulin requirements (>1.5 U/kg/day; total, 140 U/day) alongside persistent hyperglycemia. The estimated glucose disposal rate (eGDR) was 4.32 mg/kg/min, indicating significant IR. The Somogyi phenomenon was ruled out via continuous glucose monitoring (CGM), and the patient was deemed to have IR. The addition of metformin, acarbose, and dapagliflozin reduced insulin requirements and significantly improved glycemic control. This case suggests that T2D-associated genetic variants may contribute to IR in T1D and underscores the potential value of genetic testing in guiding targeted oral combination therapy.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"16 ","pages":"1656453"},"PeriodicalIF":4.6000,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12463634/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fendo.2025.1656453","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
We report a 52-year-old man with autoantibody-negative type 1 diabetes (T1D) who presented with severe insulin resistance (IR). Whole-exome sequencing (WES) identified a heterozygous mutation in the IGF2BP2 gene (c.248A>G, p. Lys83Thr; rs4402960), associated with type 2 diabetes (T2D) risk. Despite intensive insulin therapy, the patient exhibited markedly elevated insulin requirements (>1.5 U/kg/day; total, 140 U/day) alongside persistent hyperglycemia. The estimated glucose disposal rate (eGDR) was 4.32 mg/kg/min, indicating significant IR. The Somogyi phenomenon was ruled out via continuous glucose monitoring (CGM), and the patient was deemed to have IR. The addition of metformin, acarbose, and dapagliflozin reduced insulin requirements and significantly improved glycemic control. This case suggests that T2D-associated genetic variants may contribute to IR in T1D and underscores the potential value of genetic testing in guiding targeted oral combination therapy.
期刊介绍：
Frontiers in Endocrinology is a field journal of the "Frontiers in" journal series.
In today’s world, endocrinology is becoming increasingly important as it underlies many of the challenges societies face - from obesity and diabetes to reproduction, population control and aging. Endocrinology covers a broad field from basic molecular and cellular communication through to clinical care and some of the most crucial public health issues. The journal, thus, welcomes outstanding contributions in any domain of endocrinology.
Frontiers in Endocrinology publishes articles on the most outstanding discoveries across a wide research spectrum of Endocrinology. The mission of Frontiers in Endocrinology is to bring all relevant Endocrinology areas together on a single platform.
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