Treatment with Fenofibrate to a Patient with Newly Diagnosed Type 1 Diabetes, Rendering Him Insulin Independent

Rand F Al-Chalabi; Karsten Buschard; Frans Brandt

Treatment with Fenofibrate to a Patient with Newly Diagnosed Type 1 Diabetes, Rendering Him Insulin Independent

by Rand F Al-Chalabi^1*, Karsten Buschard², Frans Brandt^1,3

¹Medical Department, University Hospital of Southern Denmark, 6220 Aabenraa, Denmark

²The Bartholin Institute, Ole Maaløes Vej 5, Rigshospitalet, 2200 Copenhagen, Denmark

³Department of Regional Health Research, University of Southern Denmark, 5000 Odense C, Denmark

*Corresponding author: Rand F Al-Chalabi, Medical Department, University Hospital of Southern Denmark, 6220 Aabenraa, Denmark

Received Date: 05 May 2024

Accepted Date: 09 May 2024

Published Date: 13 May 2024

Citation: Al-Chalabi RF, Buschard K, Brandt F (2024) Treatment with Fenofibrate to a Patient with Newly Diagnosed Type 1 Diabetes, Rendering Him Insulin Independent. Ann Case Report. 9: 1799. https://doi.org/10.29011/2574-7754.101799

Abstract

A 61-year-old man was diagnosed with late-onset Type 1 Diabetes in 2018, with strong positive GAD-65, subnormal C-peptide and highly elevated HbA1C. The patient presented with symptoms of polyuria, polydipsia and fatigue. Before admission to the hospital, the patient had, started treatment with metformin, and this treatment was continued under close observation and follow-up. Fenofibrate was prescribed at four months post-diagnosis. Follow-up showed an increased C-peptide of 150% and a decrease in GAD-65 to 50 IU\L. At the 4-year follow-up, the patient still produces his own insulin, is well-regulated and has no complications. He has never needed treatment with insulin. In conclusion, a 61-year-old man with newly diagnosed Type 1 Diabetes started up with metformin and later fenofibrate, has, after 5 years not yet developed a need for insulin.

Introduction

Type 1 diabetes is an autoimmune disease that destroys pancreatic beta cells responsible for insulin production. Intensive insulin treatment is the only treatment for type 1 diabetes. Although it is effective and has saved many lives, it is also associated with complications due to the difficulty in establishing balanced glucose levels. Moreover, it requires high patient compliance and impacts daily life, causing a high psychological burden [1]. Several studies have been directed toward modulating and thus disrupting the immunological processes associated with the development of type 1 diabetes, aiming to prolong C-peptide production and insulin [2]. One study reported that fenofibrates may be used to prevent the onset of insulin dependence in non-obese mice with Type 1 Diabetes (NOD mice) [3]. Fenofibrate is a sphingolipid metabolism regulator. Sphingolipids are abnormal at the onset of Type 1 Diabetes due to their role in regulating beta-cell biology and inflammation [3]. Furthermore, fenofibrate affects the pancreatic lipidome and renders it more anti-inflammatory and anti-apoptotic. This positive effect indicates that fenofibrate can be used to improve glycemic control and prevent the development of complications [3]. In this case, fenofibrate has been used to try to prolong the ability to produce insulin; hopefully, this would render the patient insulin-independent.

Case Presentation

A 61-year-old healthy man with a BMI of about 28.6 and no familial disposition to diabetes developed polyuria, polydipsia and fatigue symptoms. He was referred to the hospital by the primary care provider due to suspicion of ketoacidosis, which was ruled out as he presented with normal acid-base balance and absence of ketonemia. At admission to the hospital, his plasma glucose concentration was 20 mmol/ml, with high positive GAD-65 (approx. 350 × 10³ IU/L) and C-peptide (752 pmol/L) levels at the time of diagnosis, and an HbA1C level of 83 mmol/mol.

Before admission to the hospital, the primary care provider started the patient on metformin due to suspicion of Type 2 Diabetes. After reading an article about the subject, 160 mg daily of fenofibrate was initiated at the four-month follow-up at the patient's request. The patient was given an insulin pen in case of emergencies. The patient has attended follow-ups at the outpatient clinic, presenting with well-controlled diabetes.

Results

The patient continues to show gradual improvement in symptoms and blood glucose levels. Blood tests showed a significant increase in C-peptides, a decrease in GAD-65 and HbA1c < 48 (Figures 1-3). The patient has only been treated with metformin and fenofibrate. Five years later, the patient still does not require insulin. Instead, the patient has well-controlled diabetes and shows no side effects to the treatment.

Figure 1: Shows levels of GAD65 and C-peptide before and after treatment with finofibrat

Figure 2: Shows levels of C-peptid before and after treatment with fenofibrat.

Figure 3: Shows level of HbA1c before and after treatment with finofibrat.

Discussion

The patient developed typical symptoms of diabetes and was diagnosed with Type 1 Diabetes based on his profile and high levels of positive antibodies to pancreatic beta cells. Since diagnosis, C-peptide levels have increased, and the patient is still independent of insulin. Type 2 Diabetes cannot be ruled out but is highly unlikely. The lack of family history, the patient’s phenotype, and highly positive antibodies strongly suggest Type 1 Diabetes. In other cases, patients with Type 1 Diabetes remain independent of insulin when treated with Fenofibrate, such as a 19-year-old girl with Type 1 Diabetes who had been insulin-independent for almost two years [4]. Our patient was treated with metformin, which is beneficial for patients with Type 1 Diabetes [5].

Our findings indicate that fenofibrate could play a role in preventing beta-cell damage in humans. An animal model has been utilized to discuss the effect of fenofibrate on specific sulfatide isoforms [6]. Fenofibrate increases the levels of the C24:0, responsible for immunogenic suppression, thus preventing diabetes in NOD mice [7]. Thus, this interesting observation of fenofibrate and Type 1 Diabetes treatment should be further explored.