ECE2022 Eposter Presentations Diabetes, Obesity, Metabolism and Nutrition (318 abstracts)
Pegylated Interferon induced Latent Autoimmune Diabetes Mellitus of Adults(LADA) in acute setting is not uncommon
Gideon Mlawa 1,2 , Chrisopher Smith 1 , 3 , Janessa Bell 3 , Hassan Rehmani 3 , Mahamud Bashir 1 , Shrini Patel 3 , Haythum Elsayed 3 , Muhammad Saleem 3 & Musarat Hussain 3
1Queen’s Hospital, London, United Kingdom; 2Queen’s Hospital, Diabetes and Endocrinology/Acute Medicine, London, United Kingdom; 3Queen’s Hospital, Acute Medicine, London, United Kingdom
Background: Pegylated interferon-alpha (IFN-α) is licensed as an antiviral, immunomodulatory and anti-proliferative therapy, but may induce autoimmune conditions including Type 1 diabetes Mellitus/latent Autoimmune Diabetes of Adults (LADA).
Case Report: A 50-year-old male presented with a 3-week history of polyuria, polydipsia and weight loss. Following review by his General Practitioner he was found to have an elevated serum glucose (55.4 mmol/l). Inpatient treatment with intravenous fluids was given alongside initiation of Metformin and Gliclazide. Further investigations revealed HbA1c 170 mmol/l and positive Anti-GAD antibody titer, confirming a diagnosis of LADA, therefore, Insulin detemir was commenced and Gliclazide was stopped. He has polycythemia Vera being treated with peginterferon alfa-2a 135 mg fortnightly, and a history of ischemic heart disease, stroke and an implantable cardioverter-defibrillator. He was taking peginterferon alpha-2a for 4 years prior to diagnosis of LADA.
Discussion: Polycythaemia Vera is a myeloproliferative disorder with Pegylated interferon-alpha as possible treatment option. Pegylated interferon-alpha therapy may be associated with onset of Diabetes mellitus, which can be acute, slow or fulminant. In our case, LADA presented 4 years after initiation of treatment. The pathogenesis of pegylated induced autoimmune diabetes is unclear. It has been proposed that pegylated interferon may shift the Th1/Th2 balance to a Th1-predominant state, resulting in an induction of Th1-type cytokines which leads to an accelerated destruction of β-cells within the pancreas as demonstrated by Murine models. Additional studies have reported high levels of anti-GAD antibodies in patients a few months after initiation of pegylated interferon treatment.
Conclusion: This case highlights causal relationship between Pegylated interferon-alpha and Type 1 autoimmune diabetes/lADA. It’s recommended that pre-treatment HbA1c is measured alongside regular serum glucose and GAD antibodies during the course of treatment with Pegylated Interferon-alpha to ensure timely diagnosis and management of diabetes.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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