五例暴发性1型糖尿病临床分析

分析5例暴发性1型糖尿病的临床资料.本组病例以起病急骤和严重的糖尿病酮症酸中毒为特征,平均病程3.4 d,入院时平均血糖47.7 mmol/L,而平均HbA_(1C) 6.8%,平均空腹C肽和餐后2 h C肽分别为40.0 pmol/L和68.0 pmol/L.随访3～26个月后胰岛β细胞功能无改善.     

暴发性1型糖尿病的临床特点及治疗分析

目的 探讨暴发性l型糖尿病的患病状况和临床特点。 方法 回顾性分析2010年1月~2015年4月我院收治的7例暴发性1型糖尿病的临床和实验室资料。 结果 暴发性l型糖尿病患者平均年龄30.8岁,平均病程2.3天,平均随机血糖水平46.4mmol/L,平均 HbA1c 6.6%,起病后迅速进展至酮症酸中毒。 结论 暴发性1型糖尿病起病急骤,代谢异常严重,胰岛β细胞严重受损,易合并多脏器功能损害,应引起临床重视。     

暴发性1型糖尿病研究现状

暴发性1型糖尿病起病急骤,病情进展迅速,短期内胰岛β细胞几乎全部破坏,临床上常以严重的酮症酸中毒为首发症状,但糖化血红蛋白却接近正常,并叮伴有胰酶水平的升高.该病在亚洲人群中多见,其确切的发病机制尚不清楚,目前认为是遗传和环境凶素共同作用的结果.现时暴发性1型糖尿病的流行病学特点、临床及免疫学特征、发病机制、诊断标准、治疗及预后进行综述.     

暴发性1型糖尿病的患病状况及其特征

目的 探讨暴发性1型糖尿病(F1D)的患病状况和临床特征.方法 采用Hanafusa提出的诊断标准,从中南大学湘雅二医院急性酮症起病的1型糖尿病患者中筛选F1D患者,再根据胰岛自身抗体谷氨酸脱羧酶抗体(GADA)或蛋白酪氨酸磷酸酶抗体的有无将非F1D患者分为经典1型组和特发1型组,比较3组患者临床特征的差异.结果 87例急性酮症起病的1犁糖尿病患者中有8例符合F1D的诊断标准,占9.1%,在18岁以上患者中占14.0%.起病时暴发组的血糖显著高于经典1型组和特发1型组(P=0.004);暴发组血淀粉酶水平显著高于经典1型组(P=0.021).4例(50%)患者发病初期GADA阳性,其中1例柯萨奇病毒B(CVB)IgM阳性,1例人单纯疱疹病毒1(HSV1)IgM阳性.结论 F1D约占以酮症或酮症酸中毒起病的1型糖尿病患者的10%.起病时F1D患者比经典1型和特发1型糖尿病患者有更严重的代谢紊乱.病毒感染和自身免疫可能参与其发病过程.     

暴发性1型糖尿病的临床诊治

暴发性1型糖尿病是一种特发性1型糖尿病,以严重酮症酸中毒、代谢紊乱为特点。本病起病急骤、进展迅速,可出现多器官功能衰竭。患者通常病情危重,若不及时抢救,病死率很高。文章对暴发性1型糖尿病的流行病学特征、病因、诊断标准、临床症状、治疗及预后进行总结,旨在加强临床医师对该病的认识。     

暴发性1型糖尿病的诊断和处理

<正>暴发性1型糖尿病(fulminant type1 diabetes,F1D)是日本Imagawa等[1]2000年提出的1型糖尿病(T1DM)的新亚型。该病发病时β细胞破坏速度,高血糖症和酮症酸中毒(DKA)进展极其迅速。发病机理有待阐明,但是,基因背景(特别是人类白细胞抗原基因HLA)和病毒被认为与该病发病相关。该型糖尿病呈超急性起病,如未及时诊断和治疗,常导致患者在短期内死亡,是急危重症。     

对暴发性1型糖尿病的探索仍在继续

暴发性1型糖尿病（FT1DM）是2000年Imagawa等[1]提出的1型糖尿病（T1DM）的新亚型,以胰岛β细胞呈超急性、完全不可逆性破坏、血糖急骤升高、糖尿病酮症酸中毒进展迅速、可缺乏糖尿病相关自身抗体为特征.FT1DM自首次被提出以来,引起了广泛关注,国内也相继有报道[2-5].目前有关FT1 DM的报道多集中在东亚人群,初步流行病学研究表明FT1DM占以酮症或糖尿病酮症酸中毒起病的T1DM患者的10％～20％[6].由于起病急骤、代谢紊乱极其严重,并可合并肝、肾、心脏、肌肉等多脏器的功能损害,如未及时诊断和治疗,常导致患者在短期内死亡.因此,作为内分泌代谢疾病中的急危重症,FT1DM应引起高度重视.     

自发酮症起病的肥胖糖尿病患者的临床特征及分型

目的 探讨自发酮症或酮症酸中毒起病的肥胖糖尿病患者的临床特征及分型。方法 将66例自发酮症起病的糖尿病患者根据体重指数分为低体重组、正常体重组和肥胖组，比较肥胖组与其它两组在年龄、性别、起病情况、谷氨酸脱羧酶抗体(GAD—Ab)和(或)蛋白酪氨酸磷酸酶抗体(IA2-Ab)阳性率及胰岛功能等方面的差异，并对肥胖组患者进行HLA—DQAl和DQBl基因分型和随访观察。结果 3组之间起病时的血糖升高、体重下降及酮症和酸中毒程度差异并无显著性，但是肥胖组与低体重组相比，存在血甘油三酯较高、GAD—Ab和(或)IA2—Ab阳性率较低、发生酮症或酮症酸中毒时的胰岛素缺乏程度较轻等特点。随访肥胖组15例患者发现有9例患者可停用胰岛素治疗。肥胖组12例抗体阴性患者中，6例不带有1型糖尿病HLA易感基因型。结论 自发酮症或酮症酸中毒起病的肥胖糖尿病患者具有明显不同于非肥胖组的临床及免疫学特征，其中一部分可考虑分型为特发性1型糖尿病。     

暴发性1型糖尿病合并重度脂肪肝1例并文献复习

暴发性1型糖尿病(fulminant type 1 diabetes,FT1DM)是21世纪以来发现的一种1型糖尿病的新亚型,其特征是起病突然,高血糖症状持续很短时间(<1周)内即出现酮症或酮症酸中毒,糖尿病相关自身抗体呈阴性,发病时几乎没有C肽分泌[1]。本病发病急且重,代谢紊乱严重,容易合并多器官损害,且缺乏特异性临床症状,除非及时准确诊断并及时治疗,否则本病难以控制,死亡风险高。     

暴发性1型糖尿病合并转氨酶急剧升高1例并文献复习

目的:提高对暴发性1型糖尿病的认识。方法:结合文献分析我科收治1例暴发性1型糖尿病合并转氨酶急剧升高的临床病历资料。结果:起病急骤,病程常<1周,且通常以酮症酸中毒起病,且比1型糖尿病更严重。且肝脏糖脂代谢紊乱严重,通常在1个月内恢复正常。结论:暴发性1型糖尿病起病急骤,代谢紊乱更严重,易合并多脏器功能损害,一经诊断应立即给予积极治疗。     

免疫检查点抑制剂治疗后发生1型糖尿病二例报道并文献综述

本文报道2例使用免疫检查点抑制剂(ICIs)治疗后发生T1DM的患者。1例为青年女性,表现为爆发性T1DM,起病时C-P无法检测出;另1例老年女性,表现为C-P逐渐下降。2例均以DKA起病。本文对2例患者的诊断及治疗进行综述并文献复习。     

酮症倾向糖尿病研究进展

酮症倾向糖尿病是一种异质性综合征,包括1型糖尿病和酮症倾向的2型糖尿病.后者的发病机制可能同糖、脂毒性所导致的严重外周胰岛素抵抗,胰岛β细胞凋亡或功能异常以及某些遗传缺陷有密切的关系.其临床特点是起病急,以酮症为首发症状.1型糖尿病需胰岛素终身治疗,对于酮症倾向的2型糖尿病,其发病机制、分型以及治疗尚无统一的标准.通过对其深入研究,有助于对糖尿病发病机制的认识及治疗方案的制订.     

Fulminant type 1 diabetes complicated by leukemoid reaction

A 28-year-old woman with severe ketoacidosis was admitted to our hospital on day 11 after giving birth. However, her HbA(1C) level was normal (5.2%) and both GAD and anti-insulin autoantibody were negative, and the WBC count was extremely high (57,500/ml) with immature leucocytes in the peripheral blood. Her WBC count decreased along with control of ketoacidosis and reduction of the plasma glucose level, and was normalized on day 5 after admission. Bone marrow aspiration subsequently showed no malignant cells, so the final diagnosis was fulminant type 1 diabetes combined with a leukemoid reaction. This is the first report of a patient with both fulminant type 1 diabetes and a leukemoid reaction. The mechanism that triggered the leukemoid reaction could not be clarified, but severe ketoacidosis may have been involved.     

Fulminant type 1 diabetes in Korea: high prevalence among patients with adult-onset type 1 diabetes

Aims/hypothesis The aim of this study was to investigate the prevalence of fulminant type 1 diabetes and the clinical characteristics of the disease among newly diagnosed Korean patients. Methods Using data retrieved from the Seoul National University Hospital database, we identified all patients newly diagnosed with type 1 diabetes from 1 January 1999 to 31 July 2006. Information on clinical manifestations and laboratory data, including the presence of islet autoantibodies detected at diagnosis, were obtained by reviewing medical records. Results We identified 99 patients newly diagnosed with type 1 diabetes. Seven patients (7.1%) fulfilled the criteria for fulminant type 1 diabetes. Among the patients aged ≥18 years at onset, 30.4% had fulminant type 1 diabetes. Patients with this diabetes subtype tested negative for islet autoantibodies, had a higher age of onset (median 28 vs 10 years, p < 0.001) and a markedly shorter duration from onset of hyperglycaemic symptoms to first hospital visit (median 3 vs 30 days, p < 0.001) than patients with non-fulminant type 1 diabetes, and showed trends of increased serum aspartate aminotransferase and amylase levels and a decreased glucagon-stimulated serum C-peptide response. Conclusions/interpretation In Korea, the prevalence of fulminant type 1 diabetes was 7.1% among all patients newly diagnosed with type 1 diabetes and 30.4% among patients with adult-onset diabetes. The clinical and metabolic characteristics of the patients with fulminant type 1 diabetes were similar to those reported in Japanese studies. Y. M. Cho and J. T. Kim contributed equally to this work.     

Fulminant diabetes mellitus associated with pregnancy: case reports and literature review

We report two cases of type 1 diabetes mellitus fulminantly developed as diabetic ketoacidosis (DKA) at 19 weeks of gestation and immediately after delivery. Development of type 1 diabetes around pregnancy is not rare, but its fulminant development is highly uncommon. We also review the relevant literature concerning mostly Japanese cases. In our cases, the group of patients with fulminant progressive diabetes mellitus associated with pregnancy required insulin replacement therapy even after the acute period and showed high value of pancreatic exocrine enzymes, i.e. amylase, elastase, and lipase. The phenotype of this group was similar to "nonautoimmune, fulminant type 1 diabetes" described by Imagawa et al., where the laboratory data of type 1 diabetes-related autoantibodies showed negative. It is well known that autoimmune diseases are in good control during pregnancy. Our present finding suggests that this type of fulminant type 1 diabetes mellitus associated with pregnancy might develop as a consequence of a nonautoimmune mechanism.     

Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitioners

Fulminant type 1 diabetes is a recently discovered subtype of type 1 diabetes. It is defined as diabetes in which the process of beta-cell destruction and the progression of hyperglycemia and ketoacidosis are extremely rapid. The pathogenesis of this disease remains to be clarified, but the involvement of both genetic background-especially human leukocyte antigen genes-and viruses has been suggested. Fulminant type 1 diabetes has the following clinical characteristics: duration of hyperglycemic symptoms is 4 days on average; there is a high prevalence of preceding common-cold-like and gastrointestinal symptoms; there is a near-normal level of glycated hemoglobin in spite of very high plasma glucose levels associated with ketoacidosis; the disease is sometimes related to pregnancy; and there are increased serum pancreatic enzyme levels, absent C-peptide levels, but virtually no detectable autoantibodies against constituents of pancreatic beta cells. The presence of the above characteristics strongly indicates the diagnosis of fulminant type 1 diabetes. Once the diagnosis of this disease is suspected, treatment of diabetic ketoacidosis must be started immediately, as in all other cases of type 1 diabetes. Otherwise, the death of the patient is likely to occur within 24 h. All medical practitioners must remember that this extremely rapidly progressing type of diabetes does exist, and they must pay special attention not to overlook it.     

Fulminant type 1 diabetes mellitus-like presentation in a Hispanic woman in the United States

Aim

To report the first case of fulminant-like type 1 diabetes mellitus in a Hispanic woman from the United States.

Method

The clinical presentation and laboratory data is presented of a Hispanic woman that was diagnosed with fulminant type 1 diabetes mellitus with a review of the literature.

Results

An 18-year-old female presented with 1 week of polydyspea and polyuria. The patient was seen by her primary care doctor and found to have an elevated blood glucose. On presentation to the hospital, she was found to be in diabetic ketoacidosis. The laboratory analysis showed a C-peptide of 0.6 ng/mL and a glycohaemoglobin A_1c of 6%. The patient had antibodies positive for glutamic acid decarboxylase. The patient was diagnosed with fulminant type 1 diabetes mellitus and was discharged in stable condition on basal/bolus subcutaneous insulin.

Conclusion

Fulminant type 1 diabetes mellitus is a recently described presentation of diabetes mellitus that has been predominately reported in Japan and other Asian countries. The classical presentation includes rapid onset on ketosis within 1 week of symptoms of hyperglycaemia, with a near-normal glycohaemoglobin and absence of C-peptide. With the majority of case being reported from Asia, it has been hypothesized that there is a genetic determent that predisposes Asian individuals to develop fulminant type 1 diabetes mellitus. The addition of the case to the medical literature expands the focus of fulminant type 1 diabetes mellitus beyond the Asian population and supports the need that further research.     

Diagnostic criteria for acute‐onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute‐onset Type 1 Diabetes Mellitus

Type 1 diabetes is a disease characterized by destruction of pancreatic β‐cells, which leads to absolute deficiency of insulin secretion. Depending on the manner of onset and progression, it is classified as fulminant, acute‐onset or slowly progressive type 1 diabetes. Here, we propose the diagnostic criteria for acute‐onset type 1 diabetes mellitus. Among the patients who develop ketosis or diabetic ketoacidosis within 3 months after the onset of hyperglycemic symptoms and require insulin treatment continuously after the diagnosis of diabetes, those with anti‐islet autoantibodies are diagnosed with ‘acute‐onset type 1 diabetes mellitus (autoimmune)’. In contrast, those whose endogenous insulin secretion is exhausted (fasting serum C‐peptide immunoreactivity <0.6 ng/mL) without verifiable anti‐islet autoantibodies are diagnosed simply with ‘acute‐onset type 1 diabetes mellitus’. Patients should be reevaluated after certain periods in case their statuses of anti‐islet autoantibodies and/or endogenous insulin secretory capacity are unknown.     

Diabetic ketoacidosis associated with Metabolife: a report of two cases

Aim: To describe two cases of diabetic ketoacidosis in newly diagnosed type 1- and type-2-diabetic individuals associated with Metabolife-356^®.
Methods: We report the acute hospitalizations and clinical courses of two individuals with diabetic ketoacidosis taking Metabolife-356^®.
Results: Both patients presented without a previous diagnosis of diabetes mellitus. One patient clinically has type 1 diabetes (positive islet cell antibodies and subnormal pancreatic beta cell function to glucagon stimulation) and is treated with insulin. The second patient, after 5 days of treatment with intravenous insulin of up to 25 units per hour, is now treated with oral medications. Several possible mechanisms may exist, including the increases in catecholamines and in blood glucose after ingestion of the ingredients of these supplements. Recent clinical trial data shows an increase in blood glucose (in non-diabetics) with these supplements despite significant weight loss at 8 weeks, although no association with diabetes mellitus has been shown in these closely monitored studies.
Conclusions: Although no precipitating factor of diabetic ketoacidosis was found in these individuals, the dietary supplement Metabolife cannot be established as a precipitant. However, patients with diabetes should take this supplement only after consultation with their health care provider, as stated on the product label. Most individuals using this supplement meet the current criteria for screening to detect undiagnosed diabetes mellitus and should consider these tests.