Encephalomyocarditis-virus-induced diabetes model resembles “fulminant” Type 1 diabetes in humans

Excerpt

To the Editor: “Fulminant” Type 1 diabetes, characterised by diabetic ketoacidosis, low HbA₁c level at onset, insulin deficiency and elevated serum pancreatic enzymes, has been reported in the Japanese population of Type 1 diabetes patients [1]. The study reported that islet-associated autoantibody was not detected, and insulitis was not found on pancreatic biopsy within 5 months of the onset of disease. Therefore, this type of diabetes was described as a subtype of Type 1B diabetes [1]. However, others reported clear T cell insulitis at autopsy in a patient who died 40 minutes after arrival at hospital [2], and a nationwide survey of fulminant Type 1 diabetes revealed that approximately 5% of patients had anti-GAD antibody in their serum [3], suggesting that autoimmunity may be involved in this type of Type 1 diabetes. Following the first report on fulminant Type 1 diabetes [1], many others tried to find a similar phenotype of Type 1 diabetes in the Caucasian population, but they reported that very few cases were found [4]. Therefore, although establishment of the diagnosis and treatment of this subtype of Type 1 diabetes is required at a nationwide level in Japan due to its aggressive disease course, it seems that very few Caucasian researchers are interested in fulminant Type 1 diabetes. …