Abstract
Fulminant type 1 diabetes is a recently discovered subtype of idiopathic type 1 diabetes, defined as diabetes with an extremely rapid process of β-cell destruction and progression to hyperglycemia and ketoacidosis. In this report, we present a case of fulminant type 1 diabetes in a 45-year-old Chinese woman, along with a review of the literature. The patient presented with sudden onset of polydipsia and polyuria after flu-like symptoms. Findings on admission included a high blood glucose level and ketoacidosis, but normal HbA1c level. The C-peptide stimulation test showed severe impairment of insulin secretion. Autoantibodies to glutamic acid decarboxylase (GAD) were negative. These results are compatible with the diagnosis of fulminant type 1 diabetes. Human leukocyte antigen-DR7 (HLA-DR7) was available in this case. It is concluded that this rapidly progressing type of diabetes exists, and we propose that HLA-DR7 might be predisposed to fulminant type 1 diabetes in Chinese patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Akatsuka, H., Yano, Y., Gabazza, E.C., Morser, J., Sasaki, R., Suzuki, T., Fujiwara, R., Katsuki, A., Takei, Y., Sumida, Y., 2009. A case of fulminant type 1 diabetes with coxsackie B4 virus infection diagnosed by elevated serum levels of neutralizing antibody. Diabetes Res. Clin. Pract., 84(3):e50–e52. [doi:10.1016/j.diabres.2009.03.009]
Cho, Y.M., Kim, J.T., Ko, K.S., Koo, B.K., Yang, S.W., Park, M.H., 2007. Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes. Diabetologia, 50(11):2276–2279. [doi:10.1007/s00125-007-0812-z]
Goto, A., Takahashi, Y., Kishimoto, M., Nakajima, Y., Nakanishi, K., Kajio, H., Noda, M., 2008. A case of fulminant type 1 diabetes associated with significant elevation of mumps titers. Endocr. J., 55(3):561–564. [doi:10.1507/endocrj.K07E-126]
Hanafusa, T., Imagawa, A., 2007. Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitioners. Nature clinical practice. Endocrinol. Metabol., 3(1):36–45.
Imagawa, A., Hanafusa, T., 2006. Pathogenesis of fulminant type1 diabetes. Rev. Diabet. Stud., 3(4):169–177. [doi:10.1900/RDS.2006.3.169]
Imagawa, A., Hanafusa, T., Miyagawa, J., Matsuzawa, Y., Osaka IDDM Study Group, 2000. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. N. Engl. J. Med., 342(5):301–307. [doi:10.1056/NEJM200002033420501]
Imagawa, A., Hanafusa, T., Uchigata, Y., Kanatsuka, A., Kawasaki, E., Kobayashi, T., Shimada, A., 2003. Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care, 26(8):2345–2352. [doi:10.2337/diacare.26.8.2345]
Imagawa, A., Hanafusa, T., Uchigata, Y., Kanatsuka, A., Kawasaki, E., Kobayashi, T., Shimada, A., Shimizu, I., Maruyama, T., Makino, H., 2005. Different contribution of class II HLA in fulminant and typical autoimmune type 1 diabetes mellitus. Diabetologia, 48(2):294–300. [doi:10.1007/s00125-004-1626-x]
Kawabata, Y., Ikegami, H., Awata, T., Imagawa, A., Maruyama, T., Kawasaki, E., Tanaka, S., Shimada, A., Osawa, H., Kobayashi, T., et al., 2009. Differential association of HLA with three subtypes of type 1 diabetes: fulminant, slowly progressive and acute-onset. Diabetologia, 52(12):2513–2521. [doi:10.1007/s00125-009-1539-9]
Kawasaki, E., Eguchi, K., 2006. Genetics of fulminant type 1 diabetes. Ann. N. Y. Acad. Sci., 1079(1):24–30. [doi:10.1196/annals.1375.004]
Kawasaki, E., Imagawa, A., Makino, H., Uga, M., Abiru, N., Hanafusa, T., Uchigata, Y., Eguchi, K., 2008. Differences in the contribution of the CTLA4 gene to susceptibility to fulminant and type 1A diabetes in Japanese patients. Diabetes Care, 31(8):1608–1610. [doi:10.2337/dc08-0280]
Moreau, C., Drui, D., Arnault-Ouary, G., Charbonnel, B., Chaillous, L., Cariou, B., 2008. Fulminant type 1 diabetes in Caucasians: a report of three cases. Diabetes Metab., 34(5):529–532. [doi:10.1016/j.diabet.2008.05.003]
Nagata, M., Moriyama, H., Kotani, R., Yasuda, H., Kishi, M., Kurohara, M., Hara, K., Yokono, K., 2007. Immunological aspects of ‘fulminant type 1 diabetes’. Diabetes Res. Clin. Pract., 77(3):S99–S103. [doi:10.1016/j.diabres.2007.01.041]
Sano, H., Terasaki, J., Tsutsumi, C., Imagawa, A., Hanafusa, T., 2008. A case of fulminant type 1 diabetes mellitus after influenza B infection. Diabetes Res. Clin. Pract., 79(3):e8–e9. [doi:10.1016/j.diabres.2007.10.030]
Tanaka, S., Nishida, Y., Aida, K., Maruyama, T., Shimada, A., Suzuki, M., Shimura, H., Takizawa, S., Takahashi, M., Akiyama, D., et al., 2009. Enterovirus infection, CXC chemokine ligand 10 (CXCL10), and CXCR3 circuit: a mechanism of accelerated beta-cell failure in fulminant type 1 diabetes. Diabetes, 58(10):2285–2291. [doi:10.2337/db09-0091]
Zhang, Y.J., Wen, D., 2008. Treatment of five cases of fulminant type 1 diabetes. Chin. J. Gen. Pract., 6(9):950 (in Chinese).
Zhou, J., Jia, W.P., Bao, Y.Q., Lu, W., Lu, J.Q., Li, Q., Liu, F., Wu, S.H., Xiang, K.S., 2007. A case of fulminant type 1 diabetes with rhabdomyolysis. Chin. J. Intern. Med., 46(11):944–945 (in Chinese).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Feng, Yf., Yao, Mf., Li, Q. et al. Fulminant type 1 diabetes in China: a case report and review of the literature. J. Zhejiang Univ. Sci. B 11, 848–850 (2010). https://doi.org/10.1631/jzus.B1000080
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1631/jzus.B1000080