title: Gliclazide-Induced Insulin Autoimmune Syndrome: A Rare Case Report and Review on Literature.
abstract: BACKGROUND
  Insulin Autoimmune Syndrome (IAS) is a rare condition characterized by the combination of recurrent severely spontaneous hypoglycemia without evidence of exogenous insulin administration, high concentration of total serum insulin, and the presence of a high titer of insulin autoantibody (IAA). But now we describe a case with IAS caused by gliclazide and hardly occuring hypoglycemia.
  
  
  METHODS
  A 70-year-old man with type 2 diabetes presented to our department with poor glycemic control without evidence of hypoglycemia, but the levels of serum insulin and IAA were very high. He had no exogenous insulin administration history. Switching antidiabetic therapy from gliclazide to acarbose and metformin, the patient's serum insulin level and IAA decreased gradually. Accordingly, the glycemic control improved and there was no episode of hypoglycemia.
  
  
  CONCLUSIONS
  Hence, clinicians should pay more attention to type 2 diabetic patients treated with gliclazide and detect their serum insulin concentration and IAA to exclude or diagnose IAS and perform the best therapeutic regimen to these patients.
authors.forename: Xiu
authors.initials: X
authors.lastname: Feng
authors.forename: Lu
authors.initials: L
authors.lastname: Yuan
authors.forename: Yun
authors.initials: Y
authors.lastname: Hu
authors.forename: Yunqing
authors.initials: Y
authors.lastname: Zhu
authors.forename: Fan
authors.initials: F
authors.lastname: Yang
authors.forename: Lanlan
authors.initials: L
authors.lastname: Jiang
authors.forename: Rengna
authors.initials: R
authors.lastname: Yan
authors.forename: Yong
authors.initials: Y
authors.lastname: Luo
authors.forename: Enhui
authors.initials: E
authors.lastname: Zhao
authors.forename: Chenxiao
authors.initials: C
authors.lastname: Liu
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Cao
authors.affiliation: Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, Jiangsu Province 210006, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Qinhuai District, Nanjing, Jiangsu Province 210006, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Ma
mesh_terms: D020909:Acarbose / Q000008:administration & dosage; D000368:Aged; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D057915:Drug Substitution; D005907:Gliclazide / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007330:Insulin Antibodies / Q000097:blood*; D008297:Male; D008687:Metformin / Q000008:administration & dosage; D013577:Syndrome
chemical_list: D007330:Insulin Antibodies; D008687:Metformin; D005907:Gliclazide; D020909:Acarbose
keywords: Gliclazide; hypoglycemia; insulin autoantibodies; insulin autoimmune syndrome; insulin resistance.