Clinical Characteristics of Cases that Progress Rapidly from Type 2 Diabetes to Insulin Deficiency Such as Fulminant Type 1 Diabetes: Subcommittee Report on Fulminant and Acute Type 1 Diabetes, Committee on Type 1 Diabetes, Japan Diabetes Society

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  • Hirata Takumi
    Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University
  • Shimada Akira
    Department of Internal Medicine, Saiseikai Central Hospital Committee on Type 1 diabetes
  • Imagawa Akihisa
    Department of Metabolic Medicine, Graduate School of Medicine, Osaka University Committee on Type 1 diabetes
  • Awata Takuya
    Department of Endocrinology and Diabetes, Saitama Medical University Committee on Type 1 diabetes
  • Ikegami Hiroshi
    Department of Endocrinology, Metabolism and Diabetes, Kinki University School of Medicine Committee on Type 1 diabetes
  • Uchigata Yasuko
    Diabetes Center, Tokyo Women's Medical University School of Medicine Committee on Type 1 diabetes
  • Osawa Haruhiko
    Department of Molecular and Genetic Medicine, Ehime University Graduate School of Medicine Committee on Type 1 diabetes
  • Kawasaki Eiji
    Department of Metabolism/Diabetes and Clinical Nutrition, Nagasaki University Hospital Committee on Type 1 diabetes
  • Kawabata Yumiko
    Department of Endocrinology, Metabolism and Diabetes, Kinki University School of Medicine Committee on Type 1 diabetes
  • Kobayashi Tetsuro
    Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi Committee on Type 1 diabetes
  • Shimizu Ikki
    Department of Internal Medicine, Sakakibara Heart Institute of Okayama Committee on Type 1 diabetes
  • Takahashi Kazuma
    Department of Diabetes and Metabolism, Iwate Medical University Committee on Type 1 diabetes
  • Nagata Masao
    Department of Internal Medicine, Kakogawa Municipal Hospital Committee on Type 1 diabetes
  • Makino Hideichi
    Department of Internal Medicine, Shiraishi Hospital Committee on Type 1 diabetes
  • Maruyama Taro
    Department of Internal Medicine, Saitama Social Insurance Hospital Committee on Type 1 diabetes
  • Hanafusa Toshiaki
    First Department of Internal Medicine, Osaka Medical College Committee on Type 1 diabetes Chairman

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Other Title
  • 1型糖尿病調査研究委員会（劇症および急性発症1型糖尿病分科会）報告―2型糖尿病経過中に劇症1型糖尿病様の発症様式を呈した症例の臨床的特性―
  • 1ガタ トウニョウビョウ チョウサ ケンキュウ イインカイ(ゲキショウ オヨビ キュウセイ ハッショウ 1ガタ トウニョウビョウ ブンカカイ)ホウコク 2ガタ トウニョウビョウ ケイカ チュウ ニ ゲキショウ 1ガタ トウニョウビョウ サマ ノ ハッショウ ヨウシキ オ テイシタ ショウレイ ノ リンショウテキ トクセイ

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Abstract

We performed a national survey of cases that had progressed rapidly from type 2 diabetes to insulin deficiency such as fulminant type 1 diabetes, and analyzed clinical case characteristics. We found that, compared to classical fulminant type 1 diabetes, subjects in these cases were relatively older at disease onset and had a higher body mass index (BMI), a higher rate of consciousness disturbance, a higher level of HbA1c, a lower level of arterial blood pH, and a lower level of urine C-peptide (CPR). We also found that BMI was significantly higher in cases with consciousness disturbance than in cases without. Due to their severe clinical course, it is very important that these cases be diagnosed, although 27.8 % of the cases surveyed did not comply with current diagnostic criteria for fulminant type 1 diabetes. We suggest that a combination of changes in markers such as low serum and urine CPR levels, short-term HbA1c elevation, and increases in serum pancreas exocrine enzymes, such as elastase-1 and lipase, may be useful for diagnosing these cases.<br>

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