Clinical Characteristics Of Fulminant Type 1 Diabetes Mellitus

Objective:This study intends to analyse the clinical characteristics of fulminant type 1diabetes and improve the diagnosis and treatment of this disease.It will provide guide and consultation for clinical work.Methods:A retrospective study was conducted to collect 199 cases of type 1 diabetes in the Second Affiliated Hospital of Nanchang University from July 2014 to July 2017.Among them,15 cases of newly diagnosed type 1 diabetes were collected,including8 cases of fulminant type 1 diabetes and 7 non-fulminant type 1 diabetes.The purpose of this study was to summarize and analyse the clinical characteristics of fulminant type 1 diabetes and compare the similarities and diversities between the clinical features of fulminant type 1 diabetes and non fulminant type 1 diabetes.Besides,patients with fulminant type 1 diabetes were followed up for 3months.Compared with the onset of the disease,the similarities and differences between daily total insulin dose,Fasting C peptide and 2 hours postprandial C peptide were analyzed.Besides,we evaluated the clinical outcome of fulminant type 1diabetes.Result:1.The ratio of patients with type 1 diabetes was 4%(8/199)at the Second Affiliated Hospital of Nanchang University in all patients with type 1 diabetes in the same period.The proportion of patients with type 1 diabetes was 53.3%(8/15)in all newly diagnosed patients with type 1 diabetes in the same period.2.In this study,there were 8 cases of fulminant type 1 diabetes,of which 6 were male and 2 were women.The course of disease was 1 to 6 days and their body mass index(BMI)was 26.1 to 26.5 kg / m2.In this study,their onset age of the disease was21 to 70 years old.Of them,three patients had obvious symptoms of digestive tract at onset of the disease,and 2 cases had gastrointestinal symptoms at onset of disease.3.Of the 8 patients with fulminant type 1 diabetes,seven cases were featured by diabetic ketoacidosis and one case was featured by ketosis at the beginning of the disease.In the group of fulminant type 1 diabetes,their medial course of disease was(3.3±1.7)days,and the medial plasma glucose was(47.0±19.2)mmol/L.The medial Glycolated Hemoglobin A1 C(HbA1c)level was(6.9%±0.9%),and the medial fasting C peptide(FCP)was(0.07±0.10)ng/mL;the medial of 2 hours postprandial C peptide was(0.10±0.20)ng/mL.The mean PH level was(7.28±0.11).The medial bicarbonate was(10.83 ± 4.68)mmol/L.The mean serum sodium level was(130.67±12.23)mmol/L,and the average serum chloride was(99.12±4.82)mmol/L.The medial blood potassium was(5.05±1.56)mmol/L,the mean base level was(-14.87±6.11)mmol/L.The glutamic acid decarboxylase antibody and islet cell antibody were negative in 8 patients.Except for case 1,the upper abdominal CT scan showed acute edematous pancreatitis,the other cases had no obvious abnormalities in the CT of the pancreas.4.There was no discrepancy in onset age,gender,family medical history of autoimmune disease and family medical history of diabetes in fulminant type 1diabetes assemblage compared with non fulminant type 1 diabetes assemblage.The average blood glucose level in the fulminant group was higher than that in the non-fulminant group,but there was no statistical difference(P > 0.05).The duration of fulminant type 1 diabetes assemblage was distinctly shorter than that in the non-fulminant type 1 diabetes assemblage,and the white blood cell was above the average of the non-fulminant type 1 diabetes assemblage(P < 0.01).The fasting C peptide level,2 hours postprandial C peptide level and Hemoglobin A1 c level in fulminant type 1 diabetes assemblage were lower than that of non-fulminant type 1diabetes assemblage(P < 0.05).There were no statistical differences in body mass index,the PH level,Alanine aminotransferase,Aspartate aminotransferase,Creatinine,serum potassium,serum sodium,serum chloride,Cratinekinase,serum amylase and insulin dosage(P > 0.05).5.All patients with fulminant type 1 diabetes were followed up for 3 months.Compared with the onset of the disease,the patients with fulminant type 1 diabetes had higher glycolated hemoglobin A1 C,lower fasting C peptide,lower 2 hours postprandial C peptide and larger insulin dosage,although the difference was not statistically significant(P>0.05).Conclusions:1.Fulminant type 1 diabetes was not rare in type 1 diabetes.The proportion of patients with fulminant type 1 diabetes accounted for 4% of the total number of type1 diabetes in the same period.2.Compared with non-fulminant type 1 diabetes,fulminant type 1 diabetes which was observed with multiple organ dysfunction had more complicated clinical manifestations,more serious metabolic disorders and worse prognosis.3.After intensive insulin therapy,the function of pancreatic islet beta cells was not improved.