Clinical Features Of Fulminant Type1Diabetes Mellitus

Objective： To investigate the clinical features of fulminant type1diabetesmellitus(FT1DM).Methods： Analyzed4210cases of the admitted diabetic mellitus patients in theSecond hospital of Dalian Medical University from2011to2013.123cases were type1diabetes mellitus,in which12cases were new and abrupt onset type1diabetesmellitus including4cases of fulminant type1diabetes mellitus and8cases ofnon-fulminant type1diabetes mellitus.The clinical features of FT1DM patients wereanalyzed,and compared with the clinical datas of non-FT1DM patients.Results：1. FT1DM accounted for about1‰（4/4120）in the consecutive hospitalizeddiabetes,33.3%in ketosis-onset or ketoacidosis-onset hospitalized T1DM in theSecond hospital of Dalian Medical University.2. Among4FT1DM patients,3were male,1was female.The onset age of FT1DMpatients was20to35years old,and duration from the onset of hyperglycemicsymptoms to ketosis-or ketoacidosis was3to6days.Body mass index (BMI) was21.0to29.1kg/m2. They all had incentives and gastrointestinalsymptoms. No hormone and drug or food allergy history.3.The onset plasma glucose of FT1DM ranged from22.34to50.50mmol/L,theaverage was33.08±12.21mmol/L;Hemoglobin A1c (HbA1c) waved in6.2～7.1%,themean was6.68±0.38%.Fasting C peptide(FCP) waved in0.06～0.28ng/ml，theaverage was0.18±0.10ng/ml； Postprandial C peptide(PCP) ranged from0.05to0.48ng/ml，the average was0.23±0.18ng/ml.pH waved in7.104～7.212,the averagewas7.16±0.05.Glutamic decarboxylase antibody (GAD-Ab) and insulin autoimmuneantibody (IAA) were negative.All white blood cell count were increased.Two FT1DM patients’ serum amylase and serum creatinine were elevated.Epstein-barr virusantibodies were positive in two FT1DM patients.One FT1DM patient with lowerserum albumin.4. No difference in onset sex,onset years old and family history of diabetes betweenFT1DM patients and non-FT1DM patients.FT1DM patients’ plasma glucose abovedthose of non-FT1DM patients,but no significantly difference(33.08±12.21mmol/L vs23.02±13.35mmol/L，P>0.05）. BMI、alanine aminotransferase、creatinine、serumpotassium and white blood cell count of FT1DM patients were higher thannon-FT1DM,while HbA1c and PCP of FT1DM patients were lower than non-FT1DM,（P<0.05）.No difference in FCP、aspartate aminotransferase、albumin、cholesterol、triglyceride、high density lipoprotein、low density lipoprotein、natrium、pH and highsensitive C-reactive protein（P>0.05）. No difference in the average daily insulin dose（0.69±0.19U/kg vs0.75±0.16U/kg，P>0.05）.5. No obvious difference in FCP and PCP before and after treatment.6.One FT1DM patient with intensive insulin treatment was followed up for one monthand three months,FCP and PCP were not improved.Conclusion:1.In type1diabetes mellitus patients, FT1DM was not rare.2. FT1DM patients were more likely to have lectrolyte disturbances and acute renalfunction insufficiency than non-FT1DM patients.3.FT1DM patients had no “honeymoon stage” after intensive insulin treatment.