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Tan SYT, Rama Chandran S, Yew J, Wong AJW, Gardner DSL. Fulminant type 1 diabetes, an underrecognized and unique subtype of type 1 diabetes: A case series from Singapore. J Diabetes Investig 2024; 15:786-789. [PMID: 38444298 PMCID: PMC11143410 DOI: 10.1111/jdi.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/21/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024] Open
Abstract
Fulminant type 1 diabetes (FT1D) is a unique subtype of type 1 diabetes, characterized by acute absolute insulin deficiency, severe ketosis, and increased risk of hypoglycemia, glycemic variability and microvascular complications. Seven people with FT1D were identified from two tertiary centers in Singapore. Six were Chinese, the mean age was 35 years and all were lean (mean body mass index 20.3 kg/m2). All presented with diabetes ketosis or ketoacidosis and low C-peptide. All but one had low glutamic acid decarboxylase antibodies. Nearly half had a missed/delayed diagnosis of FT1D. Three had frequent hypoglycemia, which improved after transition to continuous subcutaneous insulin infusion therapy. Individuals with FT1D experience unique diagnostic and management challenges associated with rapid absolute insulin deficiency. Greater awareness about this clinical entity is required.
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Affiliation(s)
- Sarah Ying Tse Tan
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Diabetes Center, Singapore General Hospital, Singapore, Singapore
| | - Suresh Rama Chandran
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Diabetes Center, Singapore General Hospital, Singapore, Singapore
| | - Jielin Yew
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Andy Jun-Wei Wong
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Daphne Su-Lyn Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Diabetes Center, Singapore General Hospital, Singapore, Singapore
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Yasuma T, Okano Y, Tanaka S, Nishihama K, Eguchi K, Inoue C, Maki K, Uchida A, Uemura M, Suzuki T, D'Alessandro-Gabazza CN, Gabazza EC, Yano Y. Sodium-glucose co-transporter-2 inhibitor-associated euglycemic diabetic ketoacidosis that prompted the diagnosis of fulminant type-1 diabetes: A case report. World J Clin Cases 2021; 9:3163-3169. [PMID: 33969104 PMCID: PMC8080741 DOI: 10.12998/wjcc.v9.i13.3163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/26/2021] [Accepted: 03/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fulminant type 1 diabetes mellitus (FT1DM) is a subtype of type 1 diabetes mellitus characterized by an abrupt onset and a rapid and complete functional loss of islet β cells. It is a very rare disease generally associated with ketoacidosis and the absence of circulating pancreatic islet-related autoantibodies. Diabetic ketoacidosis with normal blood glucose levels has been reported during sodium-glucose co-transporter 2 (SGLT2) inhibitor therapy.
CASE SUMMARY The patient was a 43-year-old woman that consulted a medical practitioner for malaise, thirst, and vomiting. Blood analysis showed high blood glucose levels (428 mg/dL), a mild increase of hemoglobin A1c (6.6%), and increased ketone bodies in urine. The patient was diagnosed with type 2 diabetes mellitus. The patient was initially treated with insulin, which was subsequently changed to an oral SGLT2 inhibitor. Antibodies to glutamic acid decarboxylase were negative. Four days after receiving oral SGLT2 inhibitor, she consulted at Mie University Hospital, complaining of fatigue and vomiting. Laboratory analysis revealed diabetic ketoacidosis with almost normal blood glucose levels. The endogenous insulin secretion was markedly low, and the serum levels of islet-related autoantibodies were undetectable. We made the diagnosis of FT1DM with concurrent SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis. The patient's general condition improved after therapy with intravenous insulin and withdrawal of oral medication. She was discharged on day 14 with an indication of multiple daily insulin therapy.
CONCLUSION This patient is a rare case of FT1DM that developed SGLT2 inhibitor-associated diabetic ketoacidosis with almost normal blood glucose levels. This case report underscores the importance of considering the diagnosis of FT1DM in patients with negative circulating autoantibodies and a history of hyperglycemia that subsequently develop euglycemic diabetic ketoacidosis following treatment with a SGLT2 inhibitor.
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Affiliation(s)
- Taro Yasuma
- Department of Diabetes, Metabolism, and Endocrinology and Immunology, Mie University, Tsu 514-8507, Japan
| | - Yuko Okano
- Department of Diabetes, Metabolism, and Endocrinology and Immunology, Mie University, Tsu 514-8507, Japan
| | - Soichiro Tanaka
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Kota Nishihama
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Kazuhito Eguchi
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Chisa Inoue
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Kanako Maki
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Akihiro Uchida
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Mei Uemura
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | - Toshinari Suzuki
- Department of Diabetes, Metabolism, and Endocrinology, Mie University, Tsu 514-8507, Japan
| | | | - Esteban C Gabazza
- Department of Immunology, Mie University Faculty and Graduate School of Medicine, Tsu 514-8507, Japan
| | - Yutaka Yano
- Department of Diabetes, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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Ross JJ, Wasserfall CH, Bacher R, Perry DJ, McGrail K, Posgai AL, Dong X, Muir A, Li X, Campbell-Thompson M, Brusko TM, Schatz DA, Haller MJ, Atkinson MA. Exocrine Pancreatic Enzymes Are a Serological Biomarker for Type 1 Diabetes Staging and Pancreas Size. Diabetes 2021; 70:944-954. [PMID: 33441381 PMCID: PMC7980193 DOI: 10.2337/db20-0995] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 01/04/2023]
Abstract
Exocrine pancreas abnormalities are increasingly recognized as features of type 1 diabetes. We previously reported reduced serum trypsinogen levels and in a separate study, smaller pancreata at and before disease onset. We hypothesized that three pancreas enzymes (amylase, lipase, and trypsinogen) might serve as serological biomarkers of pancreas volume and risk for type 1 diabetes. Amylase, lipase, and trypsinogen were measured from two independent cohorts, together comprising 800 serum samples from single-autoantibody-positive (1AAb+) and multiple-AAb+ (≥2AAb+) subjects, individuals with recent-onset or established type 1 diabetes, their AAb-negative (AAb-) first-degree relatives, and AAb- control subjects. Lipase and trypsinogen were significantly reduced in ≥2AAb+, recent-onset, and established type 1 diabetes subjects versus control subjects and 1AAb+, while amylase was reduced only in established type 1 diabetes. Logistic regression models demonstrated trypsinogen plus lipase (area under the receiver operating characteristic curve [AUROC] = 81.4%) performed equivalently to all three enzymes (AUROC = 81.4%) in categorizing ≥2AAb+ versus 1AAb+ subjects. For cohort 2 (n = 246), linear regression demonstrated lipase and trypsinogen levels could individually and collectively serve as indicators of BMI-normalized relative pancreas volume (RPVBMI, P < 0.001), previously measured by MRI. Serum lipase and trypsinogen levels together provide the most sensitive serological biomarker of RPVBMI and may improve disease staging in pretype 1 diabetes.
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Affiliation(s)
- James J Ross
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Clive H Wasserfall
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Rhonda Bacher
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Daniel J Perry
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Kieran McGrail
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Amanda L Posgai
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
| | - Xiaoru Dong
- Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL
| | - Andrew Muir
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Martha Campbell-Thompson
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Biomedical Engineering, College of Engineering, University of Florida, Gainesville, FL
| | - Todd M Brusko
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Desmond A Schatz
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Michael J Haller
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
| | - Mark A Atkinson
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida Diabetes Institute, Gainesville, FL
- Department of Pediatrics, University of Florida Diabetes Institute, Gainesville, FL
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Egashira F, Kawashima M, Morikawa A, Kosuda M, Ishihara H, Watanabe K. A rare case of fulminant type 1 diabetes mellitus accompanied by both acute pancreatitis and myocarditis - case report. BMC Endocr Disord 2020; 20:127. [PMID: 32811476 PMCID: PMC7437161 DOI: 10.1186/s12902-020-00607-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fulminant type 1 diabetes mellitus (FT1D) is a newly established subtype of type 1 diabetes. Its etiology has not been fully elucidated. Several cases with FT1D have exhibited pancreatitis or myocarditis. CASE PRESENTATION We report a 31-year-old Japanese woman who showed upper abdominal pain and was admitted to a local hospital. She was initially diagnosed with acute pancreatitis based on serum amylase elevation and swelling of the pancreas on computed tomography. Four days after admission, she developed diabetic ketoacidosis and was transferred to our hospital. Her symptoms and laboratory findings met the FT1D criteria. On the 3rd hospital day, electrocardiography (ECG) showed ST-segment elevation, and serum cardiac enzymes were markedly elevated. Because she exhibited late gadolinium enhancement in the apical wall on contrast-enhanced cardiac magnetic resonance imaging, she was diagnosed as acute myocarditis. Abnormal ECG findings and elevations of biomarkers associated with myocarditis showed improvement on the next day. CONCLUSIONS This is the first case of FT1D accompanied by both pancreatitis and myocarditis and suggests that the pathophysiology of FT1D is related to the common etiology of acute pancreatitis and myocarditis.
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Affiliation(s)
- Fujiko Egashira
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Midori Kawashima
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Ai Morikawa
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Minami Kosuda
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Hisamitsu Ishihara
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kentaro Watanabe
- Division of Diabetes and Metabolic Diseases, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Takita M, Jimbo E, Fukui T, Aida K, Shimada A, Oikawa Y, Yagihashi S, Miura J, Babazono T, Kobayashi T. Unique Inflammatory Changes in Exocrine and Endocrine Pancreas in Enterovirus-Induced Fulminant Type 1 Diabetes. J Clin Endocrinol Metab 2019; 104:4282-4294. [PMID: 31112279 DOI: 10.1210/jc.2018-02672] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/15/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT There are scant reports on the pathological changes of the exocrine and endocrine pancreas in fulminant type 1 diabetes mellitus (FT1DM). OBJECTIVE To clarify the distinct pathological changes in the exocrine as well as the endocrine pancreas shortly after onset of diabetes in FT1DM. DESIGN The exocrine and endocrine pancreases of 3 patients with FT1DM and 17 nondiabetic controls were immunohistochemically examined for islet and exocrine tissue inflammation, infiltrating mononuclear cell (MNC) CD subtype, enterovirus capsid protein 1 (VP1) localization, and CXC chemokine ligand 10 (CXCL10) and CXC chemokine receptor 3 (CXCR3) expressions. RESULTS The median frequency of insulitis in the 3 FT1DM pancreases was 60%. In the nondiabetic control pancreases, no insulitis was observed. In the islets of FT1DM, the numbers of CD45+, CD3+, CD8+, CD68+, and CD11c+ MNCs were significantly higher than those of the control group. In the exocrine pancreas of FT1DM, the numbers of CD3+ T cells, CD8+ T cells, CD68+ macrophages, and CD11c+ dendritic cells were significantly higher than those of the control group. Infiltrating CD8+ T cells, CD68+ macrophages, and CD11c+ dendritic cells were observed around exocrine acinar cells in FT1DM. There was a close association between VP1 and CXCL10 expression in pancreatic exocrine ductal cells and acinar cells as well as islet cells in FT1DM. CXCL10+ exocrine cells were surrounded by CXCR3+ T cells. CONCLUSION The pathological findings suggested that suppression of the activated CXCL10-CXCR3 axis in the exocrine as well as the endocrine pancreas is a novel therapeutic target in FT1DM and possibly in enterovirus-associated acute-onset type 1 diabetes.
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Affiliation(s)
- Mikako Takita
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Diabetes Center, Tokyo Woman's Medical University School of Medicine, Tokyo, Japan
| | - Erika Jimbo
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Tomoyasu Fukui
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kaoru Aida
- Department of Diabetic Medicine, Kanoiwa General Hospital, Yamanashi, Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Saitama, Japan
| | - Yoichi Oikawa
- Department of Endocrinology and Diabetes, School of Medicine, Saitama Medical University, Saitama, Japan
| | - Soroku Yagihashi
- Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junnosuke Miura
- Diabetes Center, Tokyo Woman's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Diabetes Center, Tokyo Woman's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuro Kobayashi
- Division of Immunology and Molecular Medicine, Okinaka Memorial Institute for Medical Research, Tokyo, Japan
- Department of Endocrinology and Metabolism, Toranomon Hospital, Tokyo, Japan
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Fulminant type 1 diabetes: A distinct subtype of type 1 diabetes mellitus. J Formos Med Assoc 2013; 112:363-4. [PMID: 23787014 DOI: 10.1016/j.jfma.2011.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 08/23/2011] [Accepted: 08/26/2011] [Indexed: 12/15/2022]
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Abstract
A 34-year-old man was admitted to our hospital with diabetic ketoacidosis due to fulminant type 1 diabetes. The patient's pancreatic exocrine and endocrine functions were as follows: the bentiromide (PABA) test value on day 14 was 33.9%, thus indicating exocrine dysfunction. One year and a half later, the PABA test value had improved to 71.0%. On the other hand, the serum C-peptide level after meal ingestion was under the detection limit. The mechanisms underlying pancreatic exocrine abnormalities seem to be different from those underlying accelerated pancreatic beta-cell failure in patients with fulminant type 1 diabetes.
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Affiliation(s)
- Hajime M Koyano
- Department of Internal Medicine, Tokyo Rinkai Hospital, Japan.
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Zheng C, Zhou Z, Yang L, Lin J, Huang G, Li X, Zhou W, Wang X, Liu Z. Fulminant type 1 diabetes mellitus exhibits distinct clinical and autoimmunity features from classical type 1 diabetes mellitus in Chinese. Diabetes Metab Res Rev 2011; 27:70-8. [PMID: 21218510 DOI: 10.1002/dmrr.1148] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/14/2010] [Accepted: 10/12/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND fulminant type 1 diabetes mellitus (T1DM) is characterized by abrupt onset of hyperglycemia and rapid progression to ketoacidosis. This study aimed at examining the clinical and autoimmunity features of fulminant T1DM in Chinese. METHODS a total of 24 patients with fulminant T1DM and 48 classical autoimmune T1DM patients with acute onset of ketoacidosis were recruited. Anthropometric and biochemical parameters were tested. Serum antibodies against glutamic acid decarboxylase 65, tyrosine phosphatase-2 and zinc transporter 8 were measured, and human leukocyte antigen-DQ haplotypes were determined. Peripheral glutamic acid decarboxylase 65-specific T-cell responses in some subjects were determined. RESULTS compared with autoimmune T1DM patients, patients with fulminant T1DM displayed more flu-like and gastrointestinal symptoms, and had significantly higher concentrations of plasma glucose, more severe ketoacidosis, very low levels of pancreatic β-cell reserve, but only slightly increased haemoglobin A(1c) levels. In some patients, the disease onset was associated with drug-related hypersensitivity, pregnancy, or positive serum IgM against viruses. Forty percent (8/20) had low titres of autoantibodies against at least one of the islet autoantigens tested. Three out of six patients had positive glutamic acid decarboxylase-reactive Th1 responses. The frequency of human leukocyte antigen -DQA1*0102-DQB1*0601 haplotype was significantly higher in patients with fulminant T1DM. CONCLUSIONS fulminant T1DM is a distinct entity with unique clinical characteristics and may be mediated by multiple factors, including viral infection, pregnancy, and drug sensitivity syndrome, among others, in the presence of humoral and/or cellular autoimmunity and susceptible genetic background.
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Affiliation(s)
- Chao Zheng
- Diabetes Center and Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Uchida M, Mogami O. Usefulness of breath test for evaluating pancreatic exocrine function using N-benzoyl-L-tyrosyl-1-13C-L-alanine sodium in non-invasive and conscious rats. Biol Pharm Bull 2008; 31:785-8. [PMID: 18451494 DOI: 10.1248/bpb.31.785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
N-Benzoyl-L-tyrosyl-1-13C-L-alanine sodium is a dipeptide used for evaluating pancreatic exocrine function. The method of evaluation, however, is not yet satisfactory, especially in experimental animals. The relation between diabetes and pancreatic exocrine function also is not clear. Therefore, this study sought to establish a method for evaluating pancreatic exocrine function and to validate the method by determining non-invasively the effect of alloxan-induced diabetes in conscious rats. After fasting, rats were orally administered Racol containing N-benzoyl-L-tyrosyl-1-13C-L-alanine sodium or 1-13C-L-alanine and housed in desiccators. The expired air in the desiccator was collected in a breath-sampling bag using a tube and aspiration pump, and the level of 13CO2 in this air was measured using an infrared spectrometer at appropriate intervals over a 120 min period. The rate of 13CO2 excretion increased, peaked and then decreased in a dose-dependent manner. The maximum concentration and area under the curve of 13CO2 excretion significantly and positively correlated with the doses of N-benzoyl-L-tyrosyl-1-13C-L-alanine sodium. In the rats made diabetes by the administration of alloxan, the level of expired 13CO2 air changed at significantly lower levels as compared with that of the control rats on day 3, although the level of expired 13CO2 air from 1-13C-L-alanine was also markedly lower than that of the control rats. These results showed that pancreatic exocrine function can be evaluated using this breath test system and that alloxan-induced diabetes affects this function.
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Affiliation(s)
- Masayuki Uchida
- Food Science Institute, Division of Research and Development, Meiji Dairies Corporation, 540 Naruda, Odawara, Kanagawa 250-0862, Japan.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2007; 14:170-96. [PMID: 17940437 DOI: 10.1097/med.0b013e3280d5f7e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Fulminant type 1 diabetes is a new subtype of type 1 diabetes. The term was established in 2000. It is a syndrome characterized by a markedly rapid and almost complete destruction of pancreatic beta-cells. Several lines of evidence suggest that both genetic factors, such as human leukocyte antigen (HLA), and environmental factors, such as viral infection, contribute to the development of this disease. It is also suggested that autoimmune processes contribute less critically to fulminant type 1 diabetes than to classic type 1A diabetes. Based on the findings made to date, both viral infection and the subsequent immune reaction in genetically susceptible individuals cause beta-cell destruction and lead to fulminant type 1 diabetes.
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