Insulin autoantibodies, D-dimer and microalbuminuria: A cross-sectional, case-control study of type 2 diabetes

doi:10.4239/wjd.v16.i2.101501

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Diabetes. Feb 15, 2025; 16(2): 101501
Published online Feb 15, 2025. doi: 10.4239/wjd.v16.i2.101501

Insulin autoantibodies, D-dimer and microalbuminuria: A cross-sectional, case-control study of type 2 diabetes

Lin-Shan Zhang, Peng Yu, Fei Yao, Zhi-Qiang Lu, Xiao-Mu Li, Hong Chen

Lin-Shan Zhang, Zhi-Qiang Lu, Xiao-Mu Li, Hong Chen, Department of Endocrinology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Peng Yu, Department of Endocrinology, Shanghai Geriatric Medical Center, Shanghai 201104, China

Fei Yao, Department of Endocrinology, Fuzhou Hospital of Traditional Chinese Medicine, Fuzhou 350000, Fujian Province, China

Co-first authors: Lin-Shan Zhang and Peng Yu.

Co-corresponding authors: Xiao-Mu Li and Hong Chen.

Author contributions: Zhang LS and Yu P contribute equally to this author as co-first authors; Li XM and Chen H contribute equally to this author as co-corresponding authors; Yu P and Yao F performed the data analysis, with Yao F also creating the figures and tables; Zhang LS and Yu P drafted the manuscript, which was subsequently revised by Chen H; Lu ZQ reviewed the manuscript and provided constructive feedback; all authors contributed to supervision, participated in the writing process, and approved the final version of the article; Chen H is responsible for all contact and correspondence with the journal.

Institutional review board statement: This study was approved by the Ethics Committee of Zhongshan Hospital, with approval number: B2020-201.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: Dataset is available from the corresponding author based on rational request.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Hong Chen, PhD, Doctor, Department of Endocrinology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China. chen.hong1@zs-hospital.sh.cn

Received: September 18, 2024
Revised: November 10, 2024
Accepted: December 2, 2024
Published online: February 15, 2025
Processing time: 104 Days and 16.9 Hours

Abstract

BACKGROUND

Type 2 diabetes mellitus (T2DM) often leads to vascular complications, such as albuminuria. The role of insulin autoantibodies (IAA) and their interaction with D-dimer in this context remains unclear.

AIM

To investigate the characteristics of IAA and its effect on albuminuria in T2DM patients.

METHODS

We retrospectively analyzed clinical data from 115 T2DM patients with positive IAA induced by exogenous insulin, and 115 age- and sex-matched IAA-negative T2DM patients as controls. Propensity scores were calculated using multivariate logistic regression. Key variables were selected using the least absolute shrinkage and selection operator (LASSO) algorithm. We constructed a prediction model and analyzed the association between IAA and albuminuria based on demographic and laboratory parameters.

RESULTS

The IAA-positive group had significantly higher D-dimer levels [0.30 (0.19-0.55) mg/L vs 0.21 (0.19-0.33) mg/L, P = 0.008] and plasma insulin levels [39.1 (12.0-102.7) μU/mL vs 9.8 (5.5-17.6) μU/mL, P < 0.001] compared to the IAA-negative group. Increases in the insulin dose per weight ratio, diabetes duration, and urinary albumin-to-creatinine ratio (UACR) were observed but did not reach statistical significance. The LASSO model identified plasma insulin and D-dimer as key factors with larger coefficients. D-dimer was significantly associated with UACR in the total and IAA-positive groups but not in the IAA-negative group. The odds ratio for D-dimer elevation (> 0.5 g/L) was 2.88 (95% confidence interval: 1.17-7.07) in the IAA-positive group (P interaction < 0.05).

CONCLUSION

D-dimer elevation is an independent risk factor for abnormal albuminuria and interacts with IAA in the development of abnormal albuminuria in T2DM patients.

Keywords: Insulin autoantibody; Microalbuminuria; D-dimer; Type 2 diabetes

Core Tip: This study explores the role of insulin autoantibodies (IAA) and their impact on albuminuria in patients with type 2 diabetes mellitus (T2DM). Our findings reveal that elevated D-dimer levels are a significant risk factor for abnormal albuminuria, particularly in the presence of IAA. This highlights a complex interaction between autoimmune responses to insulin and coagulation abnormalities, emphasizing the importance of monitoring D-dimer levels in T2DM patients with IAA for early detection and management.