Case report: Fulminant type 1 diabetes following paucisymptomatic SARS-CoV-2 infection during late pregnancy

Abstract

BackgroundDysregulation of glucose metabolism has been linked to SARS-CoV-2 infection. In addition, the occurrence of new onset diabetes mellitus, including fulminant type 1 diabetes, has been reported after SARS-CoV-2 infection or vaccination.Methods and resultsA young Chinese woman in her last trimester of pregnancy presented with an abrupt progression of hyperglycemia and ketoacidosis, but with a near-normal glycohemoglobin level following paucisymptomatic SARS-CoV-2 infection. The low C peptide levels, both fasting and postprandial, reflected profound insulin deficiency in the setting of negative islet autoantibody testing, consistent with a diagnosis of fulminant type 1 diabetes. Ketoacidosis and hyperglycemia quickly improved following the introduction of insulin therapy, but not the β cell function. The patient received treatment with insulin pump therapy after being discharged, and the first follow-up revealed a well-controlled glucose profile.ConclusionsNew-onset FT1D can occur after SARS-CoV-2 infection. Our report raises awareness of this rare but serious situation, promoting early recognition and management of FT1D during the COVID-19 pandemic.

A case of new-onset Fulminant type 1 diabetes after secondary SARS-CoV-2 infection

“…FT1D development following SARS-CoV-2 secondary infection is an exceedingly rare condition which can nevertheless endanger life due to rapid progression to diabetic ketoacidosis and almost complete failure of the pancreatic islet β cells. To date, six cases of newly diagnosed FT1D after SARS-CoV-2 vaccination have been reported [ 4 ] while only one case of new-onset FT1D caused by SARS-CoV-2 has been reported [ 5 ]. In contrast to previous reports, our case represents the sole instance aligned with the diagnosis of FT1D caused by a secondary SARS-CoV-2 infection.…”

COVID-19, Pregnancy, and Diabetes Mellitus

“…Recently, the first case of fulminant type 1 diabetes mellitus (FT1DM) has been reported in a 34-year old Chinese woman five weeks after mild COVID-19 [46]. FT1DM is characterized by a very short history of less than one week, marked symptoms with high blood glucose and relatively low HbA1c, absolute insulin deficiency, severe ketoacidosis, elevated pancreatic enzymes, and no evidence of autoimmunity.…”

“…The etiology is unknown, and some cases were associated with viral infections. The patient's OGTT test result at 25 weeks of gestation was negative [46]. She presented at 34 weeks of gestation with a one-day history of polydipsia, nausea, and vomiting in a dehydrated condition; her pre-pregnancy BMI was 21 kg/m² and none of her family members had T1DM or T2DM.…”