Comparative analysis of clinical features of fulminant type 1 diabetes / 解放军医学杂志

ABSTRACT

Objective To analyze and compare the clinical features of fulminant type 1 diabetes mellitus (FT1DM). Methods The clinical data of 135 cases of FT1DM in recent 10 years were collected. The 135 patients included those admitted in the First Medical Center of Chinese PLA General Hospital and those reported in published papers with sample number ≥10 cases. Of which the clinical data of 20 adult patients admitted in Chinese PLA General Hospital were compared with that of 87 adult patients in non-special population diagnosed by other 6 domestic hospitals. All the patients were divided into youth group with age <18 years and adult group with age ≥18 years, the clinical features of the two groups were then compared. Last, by combination of consulted literature, the data of all the Chinese adult patients recruited in present study (include the perinatal patients) were compared with that of Japanese FT1DM patients. Results The clinical features of adult patients in Chinese PLA General Hospital were similar to that of adult patients in non-special population diagnosed by other 6 domestic hospitals The age of onset ranged from 29.9 to 35.9 years, body mass index (BMI) was from 19.9 kg/m2 to 23.2 kg/m2, the course of disease ranged from 2 to 5 days. Severe hyperglycemia occurred at onset of disease, with the average HbA1c <7%. Adolescents accounted for only 13.3% of all FT1DM patients (18/135). Compared to the youth group, the adult group had more severe symptoms and more critical state of illness; the digestive tract symptoms such as nausea and vomiting were more common (P=0.026), blood glucose level at onset was higher (P=0.013), HbA1c was lower (P=0.002), acidosis was more serious (P=0.034), and serum alanine aminotransferase (ALT), creatinine and blood potassium levels increased more significantly, but the proportion of precursor infection in youth group was higher (P=0.028). In addition, no honeymoon period was found in the adult group, but 3 cases were found in the youth group (3/18, 16.7%). Compared with Japanese adult FT1DM cases, patients in China tended to be younger, lower rates of hyperglycemia, flu-like symptoms and blood glucose level, but digestive tract symptoms were more common at the same time. No significant differences existed between the two groups in BMI, course of disease, HbA1c, fasting C-peptide level, blood pH value, blood potassium level and the proportion of increased serum amylase. Conclusions No significant difference exists in clinical characteristics of adult FT1DM cases in non-special population among different regions in China. However, the symptoms are more severe and the condition is more critical in adult patients than in youth patients. Comparing the Chinese and Japanese FT1DM patients, some differences may exist in the age of onset, blood glucose level and clinical manifestations.