A follow-up study of fulminant type 1 diabetes mellitus

Abstract ObjectivesTo explore the possible mechanisms of glycol-metabolism and islet function in patients with fulminant type 1 diabetes (FT1DM).MethodsA follow-up study was conducted on 13 patients with FT1DM from September 2000 to March 2018. Patient general clinical data were collected and analyzed. The gene sequences of Human leukocyte antigen (HLA)-DRB1, HLA-DQA1 and HLA-DQB1 were analyzed by polymerase chain reaction (PCR).ResultsCompared with baseline, the waist-hip ratio was significantly increased at follow-up (P<0.05). Compared with baseline, HbA1c significantly increased; C-P0 and C-P120 significantly decreased, and the differences were statistically significant (P<0.05). Compared with baseline, White blood cell count (WBC), aspartate aminotransferase (AST), serum potassium (K), creatinine (Cr), glutamyl transpeptidase (GGT), creatine kinase (CK), alkalinity phospholipase (AKP) decreased significantly (P<0.05), while cholesterol (TC) and high-density lipoprotein (HDL) increased significantly (P<0.05). Viral antibody was detected in 13 cases of FT1DM: Coxsackie viral antibody was positive in 2 cases and herpes simplex viral antibody was positive in 3 cases. Gene detection: The higher frequency of HLA-DRB1 allele was DRB1*0301 (88.9%), DRB1*07 (44.4%), and the higher frequency of HLA-DQA1 allele was DQA1*0104 (55.6%), DQA1*0103 (44.4%), and the higher frequencies of HLA-DQB1 allele were DQB1*0201 (50.0%), DQB1*0502 (33.3%), and DQB1*0301 (25.0%).ConclusionsAlthough the β-cell function of FT1DM was progressively irreversibly destroyed with the progression of the disease, metabolic disorders and stress responses were relieved at the later stage. Viral infections (herpes simplex virus, Coxsackie virus), HLA-DQ, DR genes, GAD-Ab and other related antibodies may be involved in the occurrence of FT1DM.

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Clinical Characteristics of Fulminant Type 1 Diabetes Compared with Typical Type 1 Diabetes: One-Year Follow-Up Study from the Guangdong T1DM Translational Medicine Study

Journal of Diabetes Research ◽

10.1155/2020/8726268 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Daizhi Yang ◽

Yongwen Zhou ◽

Sihui Luo ◽

Xueying Zheng ◽

Ping Ling ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Translational Medicine ◽

Abrupt Onset ◽

Fulminant Type 1 Diabetes ◽

Metabolic Derangement ◽

One Year ◽

Fulminant Type

Background. Fulminant type l diabetes mellitus (FT1DM) is a subtype of type 1 diabetes mellitus (T1DM) with abrupt onset, but data on its progression was limited. This study was aimed at exploring the clinical features through one-year follow-up. Methods and Materials. Patients with T1DM finishing at least one-year follow-up from June 2011 to July 2018 were enrolled from Guangdong Type 1 Diabetes Translational Medicine Study. Patients who fulfilled the respective criteria were categorized as an FT1DM group and a typical T1DM group (TT1DM). The 1 : 4 propensity score matching based on onset age, duration, and gender was performed between the FT1DM and TT1DM groups. Characteristics at the onset and after one-year follow-up were compared between the two groups. Results. A total of 53 patients with FT1DM and 212 matched patients with TT1DM were included. At the onset, there was a shorter duration of symptomatic period before diagnosis observed in the FT1DM group than in the TT1DM group (2 [1, 7] vs. 30 [10, 60] days, P<0.001). FT1DM patients had higher plasma glucose levels and higher percentage of diabetes ketoacidosis (P<0.001, respectively). Both fasting and postprandial C-peptide levels (FCP and PCP, respectively) in FT1DM were significantly lower (P<0.001). At enrollment, the duration of diabetes was 0.03 (0.00, 0.81) and 0.07 (0.00, 1.11) years and the level of HbA1c was 7.21±1.56% and 10.06±3.23% (P<0.001) in the FT1DM and TT1DM groups, respectively. After one year, both FCP and PCP were still significantly lower in the FT1DM group (P<0.001, 0.022) and the HbA1c level was similar between the two groups (P=0.128). The level of HDL-C in FT1DM was significantly higher than that in the TT1DM group at enrollment (P=0.019), and the change from enrollment was significantly greater than that in the FT1DM group (P=0.042). Conclusion. Patients with FT1DM had more severe metabolic derangement and deficiency of insulin secretion than patients with TT1DM at the onset, but glycaemic and metabolic control was not worse than that in TT1DM.

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