Increased incidence of true type I diabetes acquired during pregnancy.

Abstract

A longitudinal study was carried out of all patients with newly acquired insulin dependent diabetes during pregnancy (as distinct from non-insulin-dependent gestational diabetes) seen at the Copenhagen Centre for Diabetes and Pregnancy during 1966 to 1980. The series comprised 63 patients with a mean age of 27 (SEM 1) years. At diagnosis the mean fasting blood glucose concentration was 15-6 (1.3) mmol/l and mean maximal insulin dose 49 (3) IU/day.At a prospective follow up examination a mean of 8 (SEM 1) years after diagnosis 46 of 60 patients (77%) were being treated with insulin (35 (2) IU/day) and had a very low mean stimulated plasma C peptide value (0.12 (0.02) nmol/l) suggesting absent or nearly absent ,1 cell function. The remaining 14 patients (23%), not currently receiving insulin, appeared to be severely glucose intolerant, having a mean fasting blood glucose concentration of 13-4 (1.2) mmol/1' Thus most of these patients developing insulin dependent diabetes during pregnancy had true type I disease.Compared with the age specific incidence of type I diabetes in the background population of women the incidence was at least 70% higher in pregnant, than non-pregnant women (p<0-001; X2=11-6; f=1). This increased incidence occurred in the third trimester when the risk ofdeveloping type I diabetes was 3-8 times that of non-pregnant women (p<0000001; X2=356; f= 1). Finally, the risk of developing insulin dependent diabetes during pregnancy was lower when conception occurred in the winter (p<0.05; X2=4 18; f=1).

Fulminant Type 1 Diabetes

“…Another important finding was that fulminant diabetes accompanied pregnancy in 21.0% of females ages 13-49 years, and the incidence clearly increased in the third trimester of pregnancy. This finding was compatible with the fact that the incidence of type 1 was tripled in the third trimester (29).…”

Differing Causes of Pregnancy Loss in Type 1 and Type 2 Diabetes

“…In our series, the presentation varied from modest hyperglycemia, not requiring insulin treatment, through to diabetic ketoacidosis. An increased rate of presentation of type 1 diabetes in pregnancy has previously been described (29).…”

The Incidence of Type 1 Diabetes in the Age Group 0–39 Years Has Not Increased in Antwerp (Belgium) Between 1989 and 2000

“…Future research should confirm this observation in other populations and should try to identify this putative selective accelerator of subclinical diabetes in male subjects in the perspective of developing primary prevention (2). Because puberty and pregnancy are believed to precipitate clinical presentation of type 1 diabetes (22,27), an increased metabolic burden on ␤-cells could represent such an accelerator. Rapid growth rate, cold climate, acute infection, and psychological stress have all been suggested as risk factors for type 1 diabetes increasing the ␤-cell workload (28).…”