A Case of Fulminant Type 1 Diabetes With Strong Evidence of Autoimmunity

Shimada, Akira; Oikawa, Yoichi; Shigihara, Toshikatsu; Senda, Tomoko; Kodama, Keiichi

doi:10.2337/diacare.25.8.1482

Cited by 25 publications

(14 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tanaka et al (16) have reported insulitis in an autopsy case of fulminant type 1 diabetes, who died soon after the onset of the disease. Shimada and colleagues reported a fulminant diabetic patient with elevated serum interferon-␥-inducible protein levels (19) and another patient with increased prevalence of GADreactive peripheral T-cells (23). These findings suggest that fulminant type 1 diabetes is autoimmune related.…”

Section: Imagawa and Associatesmentioning

confidence: 85%

Fulminant Type 1 Diabetes

et al. 2003

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -To describe the clinical and immunologic characteristics of fulminant type 1 diabetes, a novel subtype of type 1 diabetes, we conducted a nationwide survey.RESEARCH DESIGN AND METHODS -History and laboratory data, including isletrelated autoantibodies, were examined in 222 patients with fulminant and nonfulminant type 1 diabetes in our hospitals in addition to another 118 patients with fulminant type 1 diabetes located outside our hospitals in Japan.RESULTS -In our hospitals, of the 222 patients studied, 43 (19.4%) were diagnosed with fulminant type 1 diabetes, 137 (61.7%) were classified as having autoimmune type 1 diabetes, and 42 were type 1 diabetic subjects who were not fulminant and did not have anti-islet antibodies. An additional 118 fulminant patients outside our hospitals were enrolled, making a total of 161 fulminant type 1 diabetic subjects (83 male and 78 female subjects; 14 children/ adolescents and 147 adults) identified from all over Japan. (In 2000, the average incidence was three cases per month.) Flu-like symptoms and pregnancy were more frequently observed in the fulminant than in the autoimmune group (P Ͻ 0.001). In the fulminant patients, 4.8% were positive for anti-GAD antibodies and none were positive for anti-islet antigen 2 antibodies.CONCLUSIONS -Fulminant type 1 diabetes is a distinct subtype and accounts for ϳ20% of the ketosis-onset type 1 diabetes cases in Japan. Flu-like symptoms are characteristic of disease onset. Metabolic derangement is more severe in this subtype than in autoimmune type 1 diabetes. Diabetes Care 26:2345-2352, 2003T ype 1 (insulin-dependent) diabetes is characterized by insulin deficiency from the destruction of pancreatic ␤-cells. According to the recently proposed classification of diabetes by the American Diabetes Association (ADA) and the World Health Organization (WHO), type 1 diabetes is divided into two subtypes: autoimmune type 1 (immune-mediated; type 1A) diabetes and idiopathic (type 1B) diabetes (1,2).Since 1974, when Bottazzo et al. (3) reported the presence of islet cell antibodies (ICAs) in the sera of type 1 diabetic patients, several autoantibodies to pancreatic islet cells have been recognized as a marker of type 1 diabetes. These isletrelated autoantibodies are anti-GAD antibodies (GADAb), insulin autoantibodies (IAA), and anti-islet antigen 2 (IA-2)/ IA-2␤ antibodies (4,5).However, type 1 diabetic patients are not always positive for these autoantibodies, even at the onset of overt diabetes (6,7). Patients with type 1 diabetes who do not have islet autoantibodies at the time of diagnosis are classified as having idiopathic or type 1B diabetes. In Japan, several cases have been reported in which islet-related autoantibodies were negative and the onset of diabetes was acute (8 -12). Imagawa and colleagues (13,14) have proposed that these cases are "nonautoimmune fulminant" type 1 diabetes. The clinical characteristics of this subtype of type 1 diabetes are 1) remarkably abrupt onset of disease; 2) very short (Ͻ1 week) duration of di...

show abstract

Section: Imagawa and Associatesmentioning

confidence: 85%

Fulminant Type 1 Diabetes

et al. 2003

Self Cite

View full text Add to dashboard Cite

show abstract

“…The involvement of immunological mechanisms in beta cell destruction has been discussed. Case reports have described pancreatic insulitis in an autopsy case, and later detection of antibodies after the onset of fulminant Type 1 diabetes [6,7]. On the other hand, the involvement of viral infections has also been suggested because of the abrupt onset [8,9].…”

Section: Introductionmentioning

confidence: 99%

T lymphocyte response against pancreatic beta cell antigens in fulminant Type 1 diabetes

et al. 2004

View full text Add to dashboard Cite

Aims/hypothesis. Fulminant Type 1 diabetes is a novel subtype of Type 1 diabetes that involves the abrupt onset of insulin-deficient hyperglycaemia. This subtype appears to be non-autoimmune because of the absence of diabetes-related autoantibodies in the serum, and of insulitis in pancreatic biopsy specimens. The pathogenesis of the disease is still unknown. In this study, we investigated whether T cell autoimmune responses are involved in fulminant Type 1 diabetes. Methods. Cellular immune responses to beta cell autoantigens were studied by enzyme-linked immunospot (ELISPOT) assay in 13 fulminant Type 1 diabetic patients and 49 autoantibody-positive autoimmune Type 1 diabetic patients. Results were compared with those of 18 Type 2 diabetic patients, six secondary diabetic patients (diabetes due to chronic pancreatitis) and 35 healthy controls. Results. Nine of 13 (69.2%) GAD-reactive Th1 cells, and three of 12 (25%) insulin-B9-23-reactive Th1 cells were identified in fulminant Type 1 diabetic patients by ELISPOT, as in autoantibody-positive Type 1 diabetic patients. Four fulminant Type 1 diabetic patients possessed the highly diabetes-resistant allele DR2, three of whom had GAD-reactive Th1 cells in the periphery. Conclusions/interpretation. Peripheral immune reaction was observed in 69.2% of fulminant Type 1 diabetic patients, indicating that autoreactive T cells might contribute, at least in part, to the development of fulminant Type 1 diabetes.

show abstract

“…Another study found an association of hyperlipasemia at clinical onset of insulindependent diabetes with a high titer of islet cell cytoplasmic autoantibodies (12). In addition, another case report stated that anti-GAD antibody level showed a gradual increase during the course of the disease diagnosed as "fulminant type 1 diabetes" (13). The mechanism resulting in "fulminant type 1 diabetes" with no detectable islet-related autoantibodies at clinical onset maythus be associated to some extent with autoimmunity.…”

Section: Discussionmentioning

confidence: 99%

Fulminating Onset Type 1 Diabetes with Positivity for Anti-GAD Antibody and Elevated Pancreatic Exocrine Enzyme Concentrations

et al. 2003

View full text Add to dashboard Cite

A 52-year-old man was admitted to our hospital for diabetic ketoacidosis. On admission, HbAic was 6.5%, anti-GAD antibody 10.3 U/ml, serum amylase 144 IU//, lipase 169 XJ/l and elastase-1 1,000 ng/dl. There were no abdominal symptoms, and abdominal CT showed unremarkable findings. He was treated with intensive insulin therapy. After 1 month, urinary excretion of C-peptide was 3.8 jig/day. Serum pancreatic exocrine enzyme concentrations returned to normal after 3 months. After 10 months, anti-GAD antibody had become negative, but insulin therapy was still needed for glycemic control. This report concerns a case of autoimmunefulminating onset type 1 diabetes. (Internal Medicine 42: 517-520, 2003)

show abstract

A Case of Fulminant Type 1 Diabetes With Strong Evidence of Autoimmunity

Cited by 25 publications

References 8 publications

Fulminant Type 1 Diabetes

Fulminant Type 1 Diabetes

T lymphocyte response against pancreatic beta cell antigens in fulminant Type 1 diabetes

Fulminating Onset Type 1 Diabetes with Positivity for Anti-GAD Antibody and Elevated Pancreatic Exocrine Enzyme Concentrations

Contact Info

Product

Resources

About