Dan Yao,1 Jiefeng Jiang,1 Qianyun Zhou,1 Caiyun Feng,1 Jianping Chu,2 Zhiyan Chen,1 Jie Yang,1 Jinying Xia,3 Yujia Chen1 

1Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China; 2Department of Endocrinology, Ningbo First Hospital, Ningbo, People’s Republic of China; 3Department of Endocrinology, Ningbo No. 2 Hospital, Ningbo, People’s Republic of China

Correspondence: Jiefeng Jiang, Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Ningbo, 315799, People’s Republic of China, Tel +86-13606781301,, Email xszyyjjf@126.com Dan Yao, Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, 315799, People’s Republic of China, Tel +86-13777191528, Email 3299048@qq.com

Abstract: In recent years, there have been hundreds of reports on insulin autoimmune syndrome (IAS) globally; however, fewer than a hundred patients have undergone genetic testing. Our objective is to examine the background of IAS and the variations in drugs that trigger it among patients who have been genetically tested, aiming to deepen our understanding of this condition. HLA Analysis of 68 cases showed that DR4 is predominant, especially in individuals of East Asian descent, notably in DRB1 *0406. Methimazole was the primary drug associated with IAS in these populations, while in Caucasian individuals, the emphasis was on DRB1 *0403, with lipoic acid being the common inducer. The key factor determining disease risk is the combination of chromosomal allele variations, with HLA class II allele DR4 positive patients showing a strong association with DQA1 *0301/DQB1 *0302.

Keywords: insulin autoimmune syndrome, HLA, methimazole, α-lipoic acid