Re-Enlightenment of Fulminant Type 1 Diabetes under the COVID-19 Pandemic

Abstract

Fulminant type 1 diabetes (FT1D) is a subtype of type 1 diabetes (T1D) that is characterized by the rapid progression to diabetic ketoacidosis against the background of rapid and almost complete pancreatic islet destruction. The HbA1c level at FT1D onset remains normal or slightly elevated despite marked hyperglycemia, reflecting the rapid clinical course of the disease, and is an important marker for diagnosis. FT1D often appears following flu-like symptoms, and there are many reports of its onset being linked to viral infections. In addition, disease-susceptibility genes have been identified in FT1D, suggesting the involvement of host factors in disease development. In most cases, islet-related autoantibodies are not detected, and histology of pancreatic tissue reveals macrophage and T cell infiltration of the islets in the early stages of FT1D, suggesting that islet destruction occurs via an immune response different from that occurring in autoimmune type 1 diabetes. From 2019, coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread worldwide and became a serious problem. Reports on the association between SARS-CoV-2 and T1D are mixed, with some suggesting an increase in T1D incidence due to the COVID-19 pandemic. When discussing the association between COVID-19 and T1D, it is also necessary to focus on FT1D. However, it is not easy to diagnose this subtype without understanding the concept. Therefore, authors hereby review the concept and the latest findings of FT1D, hoping that the association between COVID-19 and T1D will be adequately evaluated in the future.

Autoimmune Events after the COVID-19 Vaccination: Case Reports and Review

“…This mechanism especially have taken place in Herpes Simplex related stromal keratitis, Enterovirus and Type 1 Diabetes and coxacki virus and autoimmune myocarditis [3,4]. Pathogenesis of Systemic Lupus Erythematosus also was explained by virus exposure, for examples; Epstein Barr (EBV), Cytomegalovirus (CMV), Human Endogen Retrovirus (HERVs) [15]. Since viruses and autoimmunity was thought very much related to each other, recently question came up about COVID-19 infection and autoimmunity.…”

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

“…Understanding these triggers and promoting factors will play an important role in the prevention and treatment of FT1D. The triggering factors of this disease have been previously reported, and include vaccine inoculation, viral infections such as SARS-CoV-2 infection, and pregnancy [ 3 ]. However, no cases of SARS-CoV-2 secondary infection triggered by FT1D have yet been reported.…”

The Effect of the SARS-CoV-2 Pandemic on Presentation with Diabetic Ketoacidosis in Children with New Onset Type 1 Diabetes Mellitus

“…These infections may trigger acute complications of T1DM, including diabetic ketoacidosis (DKA), a potentially severe and life threatening condition, and in some occasions, hypoglycemia. There are reports about the relationship between fulminant DM and different infections ( 4 , 5 , 6 , 7 ), but such reports involving Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection are rare( 8 ). However, infection is often a precipitating factor for DKA and has been reported to be responsible for more than half of cases ( 9 ).…”