Gestational diabetes mellitus combined with fulminant type 1 diabetes mellitus, four cases of double diabetes: A case report

Table 1 Clinical data of 4 cases of gestational diabetes mellitus combined fulminant type 1 diabetes mellitus in our hospital

Case	Time	IAA (0-0.4)	HbA1c	Glucose (mmol/L)			Insulin (mU/L)			C-peptid (ng/mL)
				0 min	60 min	120 min	0 min	60 min	120 min	0 min	60 min	120 min
1	P 25 wk		5.4	5.65
	Post 8 wk	36.93	6.7	5.37	17.73	25.89	> 300	> 300	> 300	0.01	< 0.05	0.18
	Post 6 months		6.5	9.56	22.69	30.25	28.3	29.6	28.1	0.07	0.14	0.16
	Post 1 yr	> 50		5.54			43.6			0.02
	Post 2.5 yr	5.15	6.6
	Post 2.7 yr		5.8	3.52			8.3			< 0.01
2	P 24 wk		6.1	5.2	8.54	6.51
	Post 1 wk	> 50	6.2	7.95	18.02	23.44	44.5	17.3	14.7	0.02	< 0.05	< 0.05
	Post 6 months		7	7.3	12.63	16.46	21.7	22.2	21.9	0.01	0.01	0.01
	Post 1yr	5.5	7.6	10.89	19.04	25.4	21.4	21.1	19.4	< 0.01	< 0.01	< 0.01
	Post 2.5 yr	> 50	6.6	3.92			10.8			< 0.01
3	P 25 wk			5.4	11.18	10.47	16.8	106.4	175.1
	P 33 wk	3.82	6.1	5.03	12.1	18.7	18.7	10.4	7.3	0.04	< 0.05	0.14
	Post 5 months	18.59	5.7	7.67			116.3			0.01
4	P 25 wk			5.9
	P 29 wk		5.7
	Post 3 d	23.2	6.1	10.46	22.07	26.82	14.1	10.4	9.9	0.13	0.27	0.51
	Post 3 months			9.1	21	25.8	< 0.2	1.03	3.08	0.06	0.207	0.435

P: Pregnant; Post: Postpartum; IAA: Insulin autoantibody; HbA1c: Hemoglobin A1C.

Table 2 Clinical characteristics of pregnancy-related fulminant type 1 diabetes mellitus vs gestational diabetes mellitus combined with fulminant type 1 diabetes mellitus

	PF (n = 105, pregnant n = 80, postpartum n = 25)	GDM combined with FT1DM (n = 7, pregnancy n = 5, postpartum n = 2)
Age of onset age, (range value)	27.9 (21-38)	31.6 (27-40)
BMI [kg/m2, (range value)]	22.1 (16.9-29.5)	23.4 (16.85-30.47)
Number of weeks of pregnancy
Pregnancy [week, (range value)]	26.2 (6-38)	36.3 (33-40)
Postpartum days [days, (range value)]	6.4 (1-15)	7.3 (3-13)
Start time [day, (range value)]	3.2 (1-9)	----
Family history (-/+)	55/9	3/4
Fetal survival (survival/ total)	13/58	7/7
Clinical manifestations
Influenza-like symptoms (%)	50 (47/94)	42.8 (3/7)
Gastrointestinal symptoms (%)	59.5 (56/94)	42.8 (3/7)
Fever: (%)	26.7 (8/30)	0/7
Consciousness disorders (%)	43.3 (13/30)	0/7
Laboratory examination
PH (range)	7.07 (6.91-7.4)	7.20 (7.08-7.36)
HbA1c [% (range value)]	6.26 (4.8-8.7)	5.92 (5.4-6.2)
Blood sugar [mmol/L, (range value)]	37.13 (16.6-78.5)	22.05 (16.0-44.9)
PG/HbA1c ratio	5.29	3.76
Fasting C Peptide (ng/mL)	0.07	< 0.04
Afteral C Peptide (ng/mL)	0.11	< 0.13
GAD (-/+)	87/7	7/0
IAA (-/+)	---	0/7 (positive at 4 cases and 3 cases positive after treatment)
Transsusceptible genotypes	HLADRB1 09:01-DQB1 03:03 (DR9)	HLADRB1 09:01, DQB1 03:03, DQA1 03:02, DPA1 01:03, DPA1 02:02, DPB1 05:01 DRB4 01:03, G 01:01, and G 01:04

PF: Pregnancy-related fulminant type 1 diabetes mellitus; GDM: Gestational diabetes mellitus; FT1DM: Fulminant type 1 diabetes mellitus; BMI: Body mass index; HbA1c: Hemoglobin A1C; PG: Postprandial glucose.