Clinical Characteristics Of Fulminant Type 1 Diabetes

Background and Objective:Fulminant type 1 diabetes mellitus(FT1DM)is relatively rare in China,and the pre-existence of the disease is lack of specificity and is easily overlooked or misdiagnosed.This study retrospectively analyzed the clinical data of patients with FT1DM admitted to Peking Union Medical College Hospital,and analyzed the clinical characteristics of the disease,thus deepening the clinician’s understanding of the disease and avoiding misdiagnosis and mistreatment.Subjects and methods:Patients admitted in Peking Union Medical College Hospital from January 2012 to December 2018 with the diagnose of FT 1 DM were enrolled in the study.All the clinical data were collected and analyzed.Results:A total of 29 patients were enrolled with 11 males and 18 females.The mean age was(34.5±10.8)years old and the median duration of the disease onset was 2(1,13)days.Among them,96.6%(28/29)patients developed diabetic ketosis(DK)or diabetic ketoacidosis(DKA)within 1 week;79.3%(23/29)had gastrointestinal symptoms;51.7%(15/29)patients was accompanied by an increase in pancreatic enzymes;48.3%(14/29)patients had cold-like symptoms right before the onset of the disease.Islet-related autoantibodies were negative in 27 patients,while glutamate decarboxylase antibody(GADA)was positive in 2 patients and 7 patients were found to be positive forautoantibodies other than islet-related autoantibodies.Rubella virus infection was confirmed in 1 case,while FI DM manifested in 4 cases soon after drug hypersensitivitysyndrome(DIHS)and 6 cases happened during pregnancy.All patients were treated withinsulin preparations,4 patients were treated with continuous subcutaneous insulin injection,while another 25 patients were treated with multiple daily insulin injections.The median insulin dosage was 0.53(0.31,0.90)U/(kg~*d).After treatment,the patient~fsplasma pancreatic enzymes returned to normal.Thirteen patients experienced frequent episodes of hypoglycemia during follow-up.By adjusting the insulin dose,4 patients had a steady blood glucose level.Nine patients manifested as robust blood glucose fluctuations and frequent hypoglycemia with high-dose insulin therapy and strict lifestyle control.Insulin autoantibodies was found to be positive in the above 9 patients,thus the diagnose of exogenous insulin antibody syndrome(EIAS)was probable.Conclusions:1.Important environmental factors for the pathogenesis of FT 1 DM include viral infections,drug allergies,and pregnancy,2.Multiple long-term complications may occur after DIHS remission,especially FT1DM.Long-term follow-up is required after DIHS and tracing DIHS history before the onset of DKA are necessary.3.FT1DM tends to occur dxxring pregnancy.When rapidly progression of hyperglycemia and DKA in pregnant women,high alertness to pregnancy-related fiilminant type 1diabetes(PF)is required.4.When encountered with unexplained blood glucose fluctuations in FT1DM patients,the possibility of EIAS should be considered.