Clinical characteristics of fulminant type 1 diabetes associated with pregnancy in China

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ORIGINAL ARTICLE

Clinical characteristics of fulminant type 1 diabetes associated with pregnancy in China Lan Liu • Jiping Mao • Zeyuan Lu • Xiaojie Yan • Xiaosu Bai • Yiyi Ye • Gang Zou

Received: 3 March 2011 / Accepted: 30 June 2011 / Published online: 22 June 2011 Ó Springer Science+Business Media, LLC 2011

Abstract To report 12 cases of pregnancy-associated fulminant type 1 diabetes mellitus (PF) found in China from 2003 to 2010. The clinical and biochemical characteristics of these cases with PF were compared with a group of cases of child-bearing age with fulminant type 1 diabetes that was not associated with pregnancy (NPF). The clinical and biochemical characteristics of 12 PF cases were analyzed retrospectively and then compared with those characteristics of 20 NPF cases in China. The difference between Chinese and Japanese PF cases was investigated. The mean values of the characteristics from PF and NPF cases in China, including postprandial serum C-peptide concentration, plasma glucose concentration, and serum chloride were different. Compared to the 22 PF cases in Japan, the mean age of these 12 PF cases was much younger. The mean fasting and postprandial serum C-peptide concentration level were lower, and the mean HbA1c levels was higher in 12 PF cases in China. Eight of 12 PF cases in China developed the disease during pregnancy. Other four PF case developed the disease within 2 weeks after delivery. 12 PF cases in China showed more

L. Liu (&)  Z. Lu  X. Yan  Y. Ye  G. Zou Department of Endocrinology, Affiliated Futian Hospital of Guangdong Medical College, Shennan zhong Road, Shenzhen 518033, China e-mail: [email protected] J. Mao Department of Endocrinology, Central South University Second Xiangya Hospital, Changsha 410011, China X. Bai Department of Geriatrics, Affiliated Futian Hospital of Guangdong Medical College, Shenzhen 518033, China

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severe beta-cell destruction, the prognosis of their fetuses was extremely poor. Keywords China

Fulminant  Type 1 diabetes  Pregnancy 

Introduction According to the classification of diabetes by the American Diabetes Association (ADA) and the World Health Organization (WHO), type 1 diabetes is divided into two subtype: autoimmune type 1 (immune-mediated; type 1A) diabetes and idiopathic (type 1B) diabetes. Fulminant type 1 diabetes mellitus (fT1DM) has been identified as a new subtype of idiopathic diabetes which was firstly introduced by Imagawa et al. in 2000 [1]. The clinical characteristics of this subtype of type 1 diabetes are: (1) remarkably abrupt onset of disease; (2) very short (\1 week) duration of diabetic symptoms; (3) acidosis at diagnosis; (4) negative status of islet-related autoantibodies; (5) virtually no C-peptide secretion (\10 lg/day in urine); and (6) elevated serum pancreatic enzyme levels [2]. One of the characteristics of fulminant type 1 diabetes is that it develops with diabetic ketoacidosis (DKA) during pregnancy without preceding diabetes. It is well-known that the immunological milieu is significantly changed duri