Late Systemic Lupus Erythematosus-Associated Insulin Resistance Syndrome: A Rare Cause of De Novo Diabetes Mellitus

Table 2

SLE-associated TBIRS patients’ description.

Gender/age, race	Time- to diabetes diagnosis	Time-to resistance	ANA titer/pattern	Acanthosis nigricans	SLE characteristics	ACRI-AAI	Maximum daily insulin dose	Treatment	Final outcome
1. F, 62 years, African American. Present case	3 months	3 months (catabolic symptoms)	1 : 2560 speckled	Yes	Raynaud’s phenomenon; Lymphopenia; Hypocomplementemia	AAI	2400 U daily dose	Pulse steroid + prednisolone	Remission (metabolic control)
2. F, 47 years, Asian. [4]	3 months	3 months (catabolic symptoms)	Positive speckled	Yes	Fever; Oral ulcers; Weight loss; Axillar lymphadenopathies; Leukopenia	ACRI	12,000 U daily dose	Pulse steroid + 20 mg for 4 weeks	2 years remission
3. F, 60 years, African American. [8]	1 year (hypoglycemia)	3 months (catabolic symptoms)	Not reported	Yes	Not reported	ACRI	Hypoglycemias with no antidiabetic drugs (despite glucocorticoids, glucagon and octreotide)	3 immunoglobulin cycles + prednisolone 60 mg daily + azathioprine 100 mg daily	Persistant hypoglycemias (12 months)
4. F, 8 years, Latina. [9]	Unknown	3 months (hypoglycemia)	1 : 640	Yes	Nephritis; Dermatomyositis; Raynaud’s phenomenon	ACRI	Hypoglycemias with doses of 1.1 U/kg/day	Mycophenolate + prednisolone + immunoglobulin + rituximab + plasmapheresis + Bortezomib	Persistant hypoglycemias (12 months)
5. F, 39 years, African American. [10]	6 months (catabolic symptoms)	1 month (hypoglycemia)	1 : 2560 speckled	Yes	Antiphospholipid antibodies	AAI	1500 U daily	Rituximab + pulse high dose dexamethasone each 4 months for 4 days + maintenance with azathioprine	Remission (12 months follow-up)
6. M, 63 years, Asian. [11]	4 months (catabolic symptoms)	4 months (uncontrolled hyperglycemia)	1 : 320	Yes	Nephritis; Cryoglobulinemia	ACRI	306 U daily	Methylprednisolone 40 mg/day + cyclophosphamide	Remission (unknown follow-up)
7. M, 60 years, Asian. [12]	Unknown	Unknown	1 : 2560 speckled	No	Ataxia photosensitivity; Thrombocytopenia; Lymphopenia; Hypocomplementemia	ACRI	Continuous infusion 9 mU/kg/min	Rituximab + prednisolone + cyclosporine	Remission (unknown follow-up)—nephrotic syndrome development
8. M, 44 years, Asian. [13]	1 year (hyperglycemia)	Unknown (hypoglycemia)	Positive—unknown titers	Yes	Polyarthralgias; Hypocomplementemia; Hypergammaglobulinemia	ACRI	Hypoglycemias with no antidiabetic drugs	Rituximab	Remission (unknown follow-up)
9. F, 46 years, Asian. [14]	No diagnosis	3 months	Positive—unknown titers	No	Raynaud’s phenomenon; Thrombocytopenia; Hypocomplementemia; Nephritis	Negative	600 U daily	Immunoglobulin + cyclophosphamide + leflunomide	Remission (unknown follow-up)
10. F, 38 years, Asian[15]	Unknown	Unknown (hypoglycemias)	Positive—unknown titers	No	Photosensitivity; Interstitial lung disease	ACRI	Hypoglycemias with no antidiabetic drugs	Prednisolone 30 mg/day + chloroquine 300 mg/day + azathioprine 50 mg/day	Remission (unknown follow-up)
11. F, 38 years, Caucasian. [16]	Unknown	2 months (renal failure and catabolic symptoms)	Positive 1 : 1280 speckled	Yes	Nephritis; Malar rash; Myalgias; Arthralgias	ACRI	2400 U daily	Mycophenolate + pulse steroids + plasmapheresis + rituximab + IV immunoglobulin	Persistant hypoglycemia with glucose supplement requirement and continuous enteral nutrition
12. F, 50 years, African American. [17]	Unknown	Unknown	Positive	No	Unknown	ACRI	1300 U daily	1 rituximab cycle + 3 pulse steroid	Remission (16 months follow-up)
13. M, 62 years, African American. [17]	Unknown	Unknown	Positive	No	Antiphospholipid antibodies	ACRI	1250 U daily	2 rituximab cycles + 3 pulse steroid	Remission (12 months follow-up)
14. M, 64 years, Caucasian. [17]	Unknown	Unknown	Positive—unknown titers	No	Unknown	ACRI	1800 U daily	2 rituximab cycles + 5 pulse steroid	Remission (3 months follow-up)
15. M, 59 years, Asian. [18]	No diagnosis	1 month (catabolic symptoms)	Positive 1 : 80 speckled	No	Raynaud’s phenomenon arthritis; Alveolar hemorrhage; Lymphadenopathies; Pancytopenia with AIHA; Hypocomplementemia	ACRI	1800 U daily	3 Cyclophosphamide cycles + prednisolone + Cyclosporine + Metformin	Remission (15 months follow-up)
16. M, 37 years, Asian. [19]	Unknown	3 months (hypoglycemias)	Positive—unknown titers	No	Oral ulcers; Fever; Arthralgias; Photosensitivity; Skin lesions	ACRI AAI	Hypoglycemias with no antidiabetic drugs	Prednisolone 60 mg/day + chloroquine 250 mg/day + cyclophosphamide 600 mg every 2 weeks for 6 months	Remission (unknown follow-up)
17. F, 50 years, from India. [20]	No diagnosis	Unknown (catabolic symptoms)	Positive 1 : 100 homogeneous	Yes	Oral ulcers; Weight loss; Fatigue; Anemia arthritis; Skin lesions	ACRI	2000 U daily	Methylprednisolone pulse + prednisolone + Azathioprine	Remission (unknown follow-up)
18. F, 23 years, Asian. [21]	No diagnosis	Unknown (catabolic symptoms)	Positive 1 : 320 speckled	Yes	Nephritis; Hypocomplementemia	ACRI	Unknown	Methylprednisolone pulse + prednisolone	Initial remission Death due to P. jirovecii pneumonia
19. F, 13 years, African American. [22]	No diagnosis	3 months	Unknown	No	Unknown	ACRI	450 U daily rosiglitazone metformin	Prednisolone 60 mg daily	Unknown
20. F, 40 years, African American. [23]	No diagnosis	1 month (asymptomatic hyperglycemia)	Unknown	Yes	Nephritis	ACRI	4500 U daily	Methylprednisolone pulse + cyclophosphamide	Remission (unknown follow-up)
21. F, 37 years, African American. [24]	No diagnosis	6 months	Positive—unknown titers	Yes	Arthritis; Raynaud’s phenomenon	ACRI	3000 U daily	Methylprednisolone pulse + Prednisolone + 5 plasmapheresis cycles + 6 cyclophosphamide cycles	Remission (11 months follow-up)
22. F, 27 years, African American. [25]	No diagnosis	Unknown	1 : 640	Yes	Pericarditis; Arthritis	ACRI	1200 U daily	2 cyclophosphamide cycles + prednisolone + maintenance with mycophenolate mofetil	Remission (unknown follow-up)
23. F, 50 years, Asian. [26]	Unknown	1 month	1 : 2560 homogeneous	Yes	Hypocomplementemia	ACRI	610  U daily	Prednisolone 30 mg + IFG-1	Remission (unknown follow-up)
24. F, 16 years, Latin. [27]	Unknown	2 months (catabolic symptoms)	1 : 1280	Yes	Nephritis; Pancytopenia; Serositis	ACRI	Unknown	Methylprednisolone pulse + 6 cyclophosphamide cycles	Remission (24 months follow-up)
25. M, 69 years, Asian. [28]	No diagnosis	13 months (hypo and hyperglycemia)	1 : 1280 speckled	Yes	Raynaud’s phenomenon; Hypocomplemententemia; Nephritis	ACRI	Unknown	2 methylprednisolone pulses + Cyclophosphamide + prednisolone 30 mg daily	Remission (unknown follow-up)
26. F, 59 years, Caucasian. [29]	No diagnosis	15 months (catabolic symptoms and hypoglycemias)	Positive speckled (no titers)	No	Hypocomplementemia; Leukopenia	ACRI	Unknown	Prednisolone for 3 months (80–40 mg/day)	Remission (unknown follow-up)
27. F, 24 years, Caucasian. [30]	No diagnosis	9 months (hypoglycemias)	Positive 1 : 64	No	Discoid lupus; Lymphadenopathies; Fever; Serositis; Arthritis leukopenia; Lymphopenia; Hypocomplementemia	ACRI	Unknown	Prednisolone for 3 months (20–5 mg/day)	Remission (unknown follow-up)
28. F, 52 years, African American. [31]	No diagnosis	1 month (hypoglycemias)	Positive 1 : 2084 homogeneous	No	Arthritis; Alopecia; Hypocomplementemia; Leukopenia	ACRI	Hypoglycemias with no antidiabetic drugs despite of daily 300 gr glucose intravenous infusion	Prednisolone (120–10 mg/day)	Remission (unknown follow-up)
29. F, 49 years, African American. [32]	2 years	14 months (catabolic symptoms)	Positive 1 : 160 speckled	Yes	Alopecia; Leukopenia; Nephritis	ACRI	24,000 daily	prednisone	Death (unknown cause)
30. F, 40 years, African American. [32]	No diagnosis	Unknown (catabolic symptoms)	Positive 1 : 360 speckled	Yes	Arthralgias; Leukopenia; Nephritis; Neurolupus	ACRI	6000 UI daily	Pulse steroids	Death (unknown cause)
31. F, 23 years, African American. [32]	Unknown	9 months (catabolic symptoms)	Positive—unknown titers	Yes	Arthritis; Leukopenia; Hypocomplementemia; Nephritis	ACRI	2600 U daily	3 plasmapheresis and lymphapheresis cycles + 3 cyclophosphamide cycles + Prednisone	Remission (unknown follow-up)
32. F, 51 years, African American. [33]	4 years	8 months (catabolic symptoms)	Positive 1 : 160 speckled	Yes	Alopecia; Hypocomplementemia	No tested	25,000 U daily	No drugs	Spontaneous remission (20 months follow-up)