A Case of Type B Insulin Resistance Syndrome Which Was Able to Evaluate the Effects of αGI and SGLT2i Using Flash Glucose Monitoring (FGM)

Abstract

The patient was a 75-year-old man whose HbA1c level had worsened rapidly from 5.9 % to 8.8 % over 3 months. Fasting hypoglycemia, postprandial hyperglycemia and hyperinsulinemia were observed, and anti-insulin receptor antibody was detected. Because of these findings, we diagnosed him with type B insulin resistance. Flash glucose monitoring (FGM) showed that dapagliflozin, empagliflozin and miglitol reduced the mean blood glucose value±standard deviation from 188±91 mg/dL to 146±82, 140±70 and 142±61 mg/dL, respectively, by improving postprandial hyperglycemia. In contrast, the percentage of time in a hypoglycemic state was increased by dapagliflozin and empagliflozin, but not miglitol. These findings indicate that miglitol is the most effective agent among these three drugs for treating cases of type B insulin resistance with postprandial hyperglycemia because of the lack of any effect on the percentage of time in a hypoglycemic state.