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Dupilumab-related type 1 diabetes in a patient with atopic dermatitis: a case report

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Abstract

Dupilumab, a humanized monoclonal antibody that inhibits both interleukin (IL)-4 and IL-13 signals, is used as a treatment for a variety of allergic diseases including atopic dermatitis. We experienced a case of dupilumab-related type 1 diabetes in a patient with atopic dermatitis. An 18-year-old female presented with thirst and polydipsia seven months after initiating dupilumab therapy for atopic dermatitis and was found to have marked hyperglycemia with ketosis. She was positive for anti-glutamic acid decarboxylase antibody, leading to the diagnosis of type 1 diabetes. She carried human leukocyte antigen (HLA) genes associated with type 1 diabetes. Most type 1 diabetes is considered a T-helper (Th) 1 type autoimmune disease, whereas IL-4 and IL-13, which are Th2 cytokines, play inhibitory roles in the pathogenesis of type 1 diabetes. This case implies that dupilumab might contribute to the development of type 1 diabetes in individuals with a genetic background of type 1 diabetes via relative Th1 dominance. To our knowledge, this is the first case of the development of type 1 diabetes during dupilumab therapy. As dupilumab therapy might accelerate the development of type 1 diabetes, it is important to note cases like this case to clarify the pathogenic mechanisms underlying dupilumab-related type 1 diabetes.

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Authors and Affiliations

  1. Division of Diabetes, Endocrinology and Metabolism, Department of Internal Medicine, Federation of National Public Service Personnel Mutual Aid Associations Tachikawa Hospital, 4-2-22 Nishikicho, Tachikawa, Tokyo, 190-8531, Japan

    Yasuharu Kurokawa & Ken Yajima

  2. Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Saitama, 350-0495, Japan

    Yoichi Oikawa & Akira Shimada

Authors
  1. Yasuharu Kurokawa
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  2. Yoichi Oikawa
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  3. Akira Shimada
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  4. Ken Yajima
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Contributions

All authors contributed to data collection and interpretation. Y.K. and K.Y. wrote the initial draft of the manuscript, and Y.O. and A.S. contributed to the discussion. All authors critically reviewed the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Ken Yajima.

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Conflict of interest

A.S. received lecture fees from Novo Nordisk Pharma Ltd., Tokyo, Japan, and Sanofi K.K., Tokyo, Japan. Other authors have no potential conflicts of interest relevant to this article.

Ethical approval

All procedures conducted herein were in accordance with the ethical standards of the institutional and national committees on human experimentation, as well as with the 1964 Helsinki Declaration and later versions.

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Written informed consent was obtained from the patient.

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Kurokawa, Y., Oikawa, Y., Shimada, A. et al. Dupilumab-related type 1 diabetes in a patient with atopic dermatitis: a case report. Diabetol Int 13, 300–303 (2022). https://doi.org/10.1007/s13340-021-00526-1

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  • DOI: https://doi.org/10.1007/s13340-021-00526-1

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