Adult-Onset Type 1 Diabetes and Pregnancy: Three Case Reports

From 5% to 10% of diabetic patients have type 1 diabetes. Here we describe three cases of adult-onset type 1 diabetes in pregnancy treated at our clinic between 2009 and 2012. Two patients came for specialist examination during pregnancy, the third after pregnancy. These women had no prior overt diabetes and shared certain characteristics, that is, no family diabetes history, age over 35, normal prepregnancy BMI, need for insulin therapy as of the early weeks of pregnancy, and high-titer anti-GAD antibody positivity. The patients had persistent diabetes after delivery, suggesting that they developed adult-onset type 1 diabetes during pregnancy. About 10% of GDM patients become pancreatic autoantibody positive and the risk of developing overt diabetes is higher when two or more autoantibodies are present (particularly GAD and ICA). GAD-Ab shows the highest sensitivity for type 1 diabetes prediction. We need to bear in mind that older patients might conceivably develop an adult-onset type 1 diabetes during or after pregnancy. So we suggest that women with GDM showing the described clinical features shall be preferably tested for autoimmunity. Pregnant patients at risk of type 1 diabetes should be identified to avoid the maternal and fetal complications and the acute onset of diabetes afterwards.

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DR15-DQ6 remains dominantly protective against type 1 diabetes throughout the first five decades of life

Diabetologia ◽

10.1007/s00125-021-05513-4 ◽

2021 ◽

Author(s):

Nicholas J. Thomas ◽

John M. Dennis ◽

Seth A. Sharp ◽

Akaal Kaur ◽

Shivani Misra ◽

...

Keyword(s):

Type 1 Diabetes ◽

Major Type ◽

Diabetes Incidence ◽

Diabetes Diagnosis ◽

Risk Haplotype ◽

Adult Onset ◽

Uk Biobank ◽

Onset Type ◽

Increased Risk

Abstract Aims/hypothesis Among white European children developing type 1 diabetes, the otherwise common HLA haplotype DR15-DQ6 is rare, and highly protective. Adult-onset type 1 diabetes is now known to represent more overall cases than childhood onset, but it is not known whether DR15-DQ6 is protective in older-adult-onset type 1 diabetes. We sought to quantify DR15-DQ6 protection against type 1 diabetes as age of onset increased. Methods In two independent cohorts we assessed the proportion of type 1 diabetes cases presenting through the first 50 years of life with DR15-DQ6, compared with population controls. In the After Diabetes Diagnosis Research Support System-2 (ADDRESS-2) cohort (n = 1458) clinician-diagnosed type 1 diabetes was confirmed by positivity for one or more islet-specific autoantibodies. In UK Biobank (n = 2502), we estimated type 1 diabetes incidence rates relative to baseline HLA risk for each HLA group using Poisson regression. Analyses were restricted to white Europeans and were performed in three groups according to age at type 1 diabetes onset: 0–18 years, 19–30 years and 31–50 years. Results DR15-DQ6 was protective against type 1 diabetes through to age 50 years (OR < 1 for each age group, all p < 0.001). The following ORs for type 1 diabetes, relative to a neutral HLA genotype, were observed in ADDRESS-2: age 5–18 years OR 0.16 (95% CI 0.08, 0.31); age 19–30 years OR 0.10 (0.04, 0.23); and age 31–50 years OR 0.37 (0.21, 0.68). DR15-DQ6 also remained highly protective at all ages in UK Biobank. Without DR15-DQ6, the presence of major type 1 diabetes high-risk haplotype (either DR3-DQ2 or DR4-DQ8) was associated with increased risk of type 1 diabetes. Conclusions/interpretation HLA DR15-DQ6 confers dominant protection from type 1 diabetes across the first five decades of life. Graphical abstract

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244-OR: Toward Improved Identification of Adult-Onset Type 1 Diabetes (T1D): Clinical Characteristics Associated with T1D Polygenic Risk Scores in the Million Veteran Program (MVP)

Diabetes ◽

10.2337/db21-244-or ◽

2021 ◽

Vol 70 (Supplement 1) ◽

pp. 244-OR

Author(s):

PETER K. YANG ◽

SANDRA JACKSON ◽

BRIAN R. CHAREST ◽

MICHAEL N. WEEDON ◽

YILING J. CHENG ◽

...

Keyword(s):

Type 1 Diabetes ◽

Clinical Characteristics ◽

Risk Scores ◽

Adult Onset ◽

Polygenic Risk ◽

Onset Type

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Pediatric Versus Adult-onset Type 1 Diabetes Mellitus: Are They Different?

RSSDI Diabetes Update 2016 ◽

10.5005/jp/books/13026_2 ◽

2017 ◽

pp. 1-1

Author(s):

Eesh Bhatia

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Adult Onset ◽

Onset Type

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Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto's thyroiditis, and Down syndrome

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/s0004-27302013000500009 ◽

2013 ◽

Vol 57 (5) ◽

pp. 388-392 ◽

Cited By ~ 3

Author(s):

Barbara Piccini ◽

Sonia Toni ◽

Lorenzo Lenzi ◽

Federica Barni ◽

Monica Guasti ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Therapy ◽

Enteral Feeding ◽

Case Reports ◽

Scientific Evidence ◽

Nutrition Therapy ◽

Artificial Nutrition ◽

Diabetic Patients ◽

Glucose Levels

The management of insulin therapy in diabetic patients who have comorbidities that involve nutritional aspects, is a major challenge for diabetes care teams. In diabetic patients with compromised nutritional status, artificial nutrition, both enteral or parenteral, may help in the treatment of chronic and acute diseases, leading to better and faster recover of the health status but, if not adequately associated with insulin therapy, it may negatively affect blood glucose levels and lead to poorer metabolic control. In particular, evidence-based recommendations for the treatment of diabetic patients during enteral nutrition therapy are not currently available and, therefore, medical practices are often based on case reports, rather than outcomes of research. We report our experience with a diabetic patient receiving nocturnal enteral feeding due to comorbidities and malnutrition, who was followed up at our centre and precociously treated with continuous subcutaneous insulin infusion after the onset of type 1 diabetes. There is great need for adequately powered randomized controlled trials to provide scientific evidence for the insulin treatment of diabetic patients undergoing enteral feeding.

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Combined Application of Nivolumab and Intravesical Bacillus Calmette-Guérin Led to Acute-Onset Type 1 Diabetes

Case Reports in Oncology ◽

10.1159/000500978 ◽

2019 ◽

Vol 12 (2) ◽

pp. 430-433 ◽

Cited By ~ 1

Author(s):

Koichi Fujiu ◽

Yasuo Fukaya ◽

Masahiro Kamimoto ◽

Hideaki Miyamoto ◽

Yue Cong ◽

...

Keyword(s):

Type 1 Diabetes ◽

Lung Resection ◽

Cancer Recurrence ◽

Complete Response ◽

Acute Onset ◽

Bacillus Calmette Guerin ◽

Onset Type ◽

Combined Application ◽

Intravesical Bcg

We report a case of acute-onset type 1 diabetes due to combined application of nivolumab and intravesical Bacillus Calmette-Guérin (BCG). An 84-year-old woman underwent lung resection for pulmonary squamous cell carcinoma. She had been treated for type 2 diabetes and later experienced lung cancer recurrence. She was started on nivolumab treatment, and complete response was achieved for one year. However, during this time, she was diagnosed with superficial bladder cancer and underwent surgery but experienced recurrence. After one month of intravesical BCG instillation, the patient developed acute-onset type 1 diabetes. Thus, we recommend that combined application of nivolumab and intravesical BCG be avoided.

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