| Objective:To investigate the prevalence, clinical characteristics and immunological characteristics of type 1 diabetes from the First Affiliated Hospital of Sun Yat-sen University. Unclassified diabetes patients were followed. To explore the reasonable classification methods, promote the diagnosis and management of type 1 diabetes and improve the understanding of the classification of diabetes. To avoid early misdiagnosis.Methods:The clinical data of patients with type 1 diabetes from 2009 to 2014 in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Unclassified diabetes patients were followed. Analysis:(1) the basic situations of patients. (2) the various cause of DK or DKA. (3) the typical clinical manifestations and complications. (4) laboratory tests such as random blood glucose, glycosylated hemoglobin, pancreatic islet beta cell function, islet autoantibodies and lipid profile. (5) the treatment. Then we investigated the prevalence, clinical characteristics and immunological characteristics of type 1 diabetes. Statistical analyses:Data evaluation was conducted via SPSS 19.0 program. Values were expressed as number (percentage) for categorical variables, and mean ± SD for continuous ones. Student’s t-test and one-way analysis of variance was used. Values of P<0.05 were considered statistically significant.Results:1、236 patients with type 1 diabetes in the First Affiliated Hospital of Sun Yat-sen University from 2009 to 2014 were followed. Latent autoimmune diabetes in adults accounted for 11.0% in total type 1 diabetes. Fulminant type 1 diabetes in 6 cases.2、236 subjects, the mean age at the time of diagnosis was 25 years old, male to female was 117/97,81.8% of the patients were in DK or DKA at initial presentation, 22.5% with complications,10.6% with obesity, hypertension or lipodystrophy,5.1% with AITD,10.2% had family history, with BMI 19.48±3.91 kg/m2, Waist 76.8 ± 7.6cm, Hip89.3 ± 5.1cm,WHR 0.84±0.07, FPG12.5±2.7mmol/L, GLU 21.5±6.3mmol/L, HBA1c11.9±1.5%, Fasting C-Peptide 0.126±0.101nmol/L, stimulated serum C-Peptide 0.251±0.204nmoI/L. GAD A, IAA, ICA positive rates were 13.1%、7.6%and5.1%.193 cases of type 1 diabetes complicated with DK or DKA, infection cases accounted for 50.3%, drugs or diet factors accounted for 27.5%, unknown reasons accounted for 22.3%. "polyuria, polydipsia" as manifestations of 180 cases (76.3%), the "weight loss" of 161 cases (68.2%),the "nausea and vomiting, poor appetite" for the performance of 135 cases (57.2%), to the "infection" features of 92 cases (39.0%).The main treatment of type 1 diabetes was multiple dose insulin injections(70.8%), continuous subcutaneous insulin infusion accounted for 11.9%, with insulin 0.69±0.35 IU/kg/d, meal insulin ratio were 54.7%±11.6%.3、In the classic type 1 diabetes, latent autoimmune diabetes in adults were with more patients in DK or DKA at initial presentation, were lower blood glucose levels, were better beta cell function, were more islet autoantibodies positive rates (P<0.05).4、Typical features of fulminant type 1 diabetes include:severe hyperglycemia and DKA shortly after the onset of diabetic symptoms and normal HBAlc levels. A rapid and almost complete destruction of beta cells leads to low C-peptide levels. Islet autoantibodies were negative.5、In adult, type 1 diabetes were more obesity, hypertension or lipodystrophy, compared with children and adolescents(P<0.05).6、Of the 12 patients who were switched from type 2 diabetes to type 1 diabetes, all tested negative for GAD, IAA, ICA and no one presented in DK or DKA. On the other hand, of the 5 patients who had a change in classification from type 1 diabetes to type 2 diabetes, one was ICA positive and 50.0% were in DK or DKA at initial presentation. The levels of C-peptide in patients with type 2 diabetes mellitus was higher than that of type 1 diabetes mellitus (P> 0.05).7、36 patients were followed, including 12 patients of type 1 diabetes,20 patients of type 2 diabetes and 5 unclassified diabetes in patients. Type 1 diabetes were with more patients in DK or DKA at initial presentation, compared with type 2 diabetes. Type 2 diabetes were with higher BMI and beta cell function (P<0.05), compared with type 1 diabetes. When to followed, two groups of patients with FPG and HBA1c were decreased (P< 0.05), type 2 diabetes mellitus patients with C-peptide was increased (P< 0.05), no change in type 1 diabetes.Conclusion:1、Adult onset was more common in type 1 diabetes from the First Affiliated Hospital of Sun Yat-sen University. Type 1 diabetes were with few obesity, hypertension or lipodystrophy, less family history, AITD, severe symptoms of polyuria, polydipsia, weight loss and ketosis. It was suggested that there were high blood glucose levels at the onset of disease, with poor pancreatic islet beta cell function and more negative for islet autoantibodies. Multiple dose insulin injections was the main treatment.2、Latent autoimmune diabetes in adults were with more patients in DK or DKA at initial presentation， better beta cell function, islet autoantibodies positive.3、Fulminant type 1 diabetes were severe hyperglycemia and DKA shortly after the onset of diabetic symptoms and normal HBAlc levels. A rapid and almost complete destruction of beta cells.Islet autoantibodies were almost negative.4、Important features of the classification of type 1 diabetes and type 2 diabetes includes:onset characteristics, ketonemia, islet autoantibodies, C-peptide levels and insulin-dependent.5、Distinguishing between type 1 diabetes and type 2 diabetes presents diagnostic challenges by the diverse clinical manifestations. The children, adolescents or adult can have type 1 diabetes or type 2 diabetes, both presented in DK or DKA, however, LADA maybe not. By the influence of getting fat and Asia "thin", figure is unrepresentative. Islet autoantibodies may have false positive or negative results.6、When to atypical types, the physician need to observe clinical manifestations and immunological characteristics for evaluation and classification. |
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