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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2025; 16(9): 109130
Published online Sep 15, 2025. doi: 10.4239/wjd.v16.i9.109130
Published online Sep 15, 2025. doi: 10.4239/wjd.v16.i9.109130
Exogenous insulin-associated autoimmunity and the emergence of double diabetes in type 2 diabetes
Xin-Gang Li, Meng-Ya Qi, Department of Endocrinology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Xiang Li, Fan Ping, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Co-first authors: Xin-Gang Li and Meng-Ya Qi.
Author contributions: Ping F conceptualized and supervised, and provided critical guidance on clinical interpretation and manuscript development; Li XG, Li X and Qi MY contributed to data collection, analysis, and drafting of the manuscript. All authors read and approved the final version of the manuscript. Li XG prepared the initial draft, which was critically reviewed and revised by all co-authors. Li XG and Qi MY contributed equally to this work as co-first authors.
Supported by CAMS Innovation Fund for Medical Sciences, No. 2021-I2M-1-002; Healthcare Quality and Safety Incubation Programme of the Peking Union Medical Foundation, No. XHFY 2406; and the National High-Level Hospital Clinical Research Funding, No. 2022-PUMCH-B-015.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of PUMCH (Approval No. K3260).
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 that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request, in accordance with institutional ethical and privacy regulations (pingfan6779@163.com).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fan Ping, Professor, Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing 100730, China. pingfan6779@163.com
Received: May 7, 2025
Revised: June 18, 2025
Accepted: August 20, 2025
Published online: September 15, 2025
Processing time: 133 Days and 21.6 Hours
Revised: June 18, 2025
Accepted: August 20, 2025
Published online: September 15, 2025
Processing time: 133 Days and 21.6 Hours
Core Tip
Core Tip: We report a rare and under-recognized subtype of double diabetes, in which insulin autoantibodies induced by exogenous insulin therapy accelerate β-cell failure in patients with type 2 diabetes. This immune-mediated phenotype-predominantly observed in East Asian populations and associated with high-risk human leukocyte antigen class II alleles highlights a novel immunogenic mechanism underlying diabetes progression.