Clinical and Immunogenetic Characteristics of Fulminant Type 1 Diabetes Associated with Pregnancy

Shimizu, Ikki; Makino, Hideichi; Imagawa, Akihisa; Iwahashi, Hiromi; Uchigata, Yasuko; Kanatsuka, Azuma; Kawasaki, Eiji; Kobayashi, Tetsuro; Shimada, Akira; Maruyama, Taro; Hanafusa, Toshiaki

doi:10.1210/jc.2005-1943

Cited by 80 publications

(85 citation statements)

References 38 publications

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“…GADAb, ICA and IA-2Ab were determined at the onset of diabetes and serum Cpeptide levels were measured, as previously described [3][4][5]. Urinary albumin concentrations were determined by turbidimetric immunoassay (TIA) or nephelometric immunoassay (NIA) using commercial kits.…”

Section: Subjectsmentioning

confidence: 99%

“…The clinical characteristics of this subtype of type 1 diabetes are: (1) remarkably abrupt onset of the disease; (2) very short duration (usually less than 1 week) of diabetic symptoms, e.g. polyuria, thirst; (3) acidosis at the time of diagnosis; (4) negative findings for islet-related autoantibodies, such as islet-cell antibodies (ICA), anti-GAD antibodies (GADAb), insulin autoantibodies or anti-insulinoma-associated antigen 2 antibodies (IA-2Ab); (5) virtually no C-peptide secretion (less than 10 μg/day in the urine); (6) elevated serum pancreatic enzyme levels; (7) frequent flu-like symptoms around the time of disease onset; (8) association with pregnancy; and (9) strong association with HLA-DR4-DQ4 haplotype [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

et al. 2007

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Aims/hypothesis The aim of the present study was to assess the development of microangiopathy in patients with fulminant type 1 diabetes, a novel subtype of type 1B diabetes. Materials and methods In a nationwide survey, we followed 41 patients with fulminant type 1 diabetes and 76 age-and sex-matched patients with type 1A diabetes for 5 years. The following data were recorded every 12 months after the onset of diabetes: seven-point blood glucose concentrations, HbA 1c level, urinary albumin excretion, serum C-peptide level, blood pressure, daily dosages of insulin, frequency of severe hypoglycaemic episodes, and neurological and fundoscopic examination. ResultsThe 5-year cumulative incidence of microangiopathy was 24.4% in fulminant type 1 diabetes and 2.6% in type 1A diabetes. In longitudinal studies using the KaplanMeier method, the cumulative incidence of each form of microangiopathy was significantly higher in fulminant type 1 diabetes than in type 1A diabetes; retinopathy was 9.8% vs 0% (p=0.014), nephropathy 12.2% vs 2.6% (p=0.015) and neuropathy 12.2% vs 1.3% (p=0.010), respectively. Mean HbA 1c levels were similar in the fulminant and type 1A diabetes groups during the follow-up periods. However, the mean M-value, mean insulin dosages and the frequency of severe hypoglycaemic episodes were significantly higher, and the mean postprandial C-peptide level was significantly lower in the fulminant type 1 diabetes group.

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Section: Subjectsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fulminant type 1 diabetes as a high risk group for diabetic microangiopathy—a nationwide 5-year-study in Japan

et al. 2007

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“…The preliminary study of CTLA-4 gene polymorphism Fulminant type 1 diabetes is not predominant in females, but pregnancy is sometimes associated with this disease [47][48][49]. Almost all patients who suffered from type 1 diabetes during pregnancy or just after delivery showed characteristics similar to the fulminant type.…”

Section: Genetic Factors -The Role Of Hlamentioning

confidence: 99%

“…Almost all patients who suffered from type 1 diabetes during pregnancy or just after delivery showed characteristics similar to the fulminant type. Shimizu et al reported on the clinical characteristics of 22 patients who developed fulminant diabetes associated with pregnancy [49]. Out of those 22 patients, 18 patients developed diabetes during pregnancy and 4 patients developed diabetes within 2 weeks after delivery.…”

Section: Genetic Factors -The Role Of Hlamentioning

confidence: 99%

Pathogenesis of Fulminant Type 1 Diabetes

Imagawa¹,

Hanafusa²

2006

Rev Diabetic Stud

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■ AbstractFulminant type 1 diabetes is a new subtype of type 1 diabetes. The term was established in 2000. It is a syndrome characterized by a markedly rapid and almost complete destruction of pancreatic β-cells. Several lines of evidence suggest that both genetic factors, such as human leukocyte antigen (HLA), and environmental factors, such as viral infection, contribute to the development of this disease. It is also suggested that autoimmune processes contribute less critically to fulminant type 1 diabetes than to classic type 1A diabetes. Based on the findings made to date, both viral infection and the subsequent immune reaction in genetically susceptible individuals cause β-cell destruction and lead to fulminant type 1 diabetes.

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“…However the degradation mechanism of cell in FT1DM of humans is unknown. Recently, it has been reported that the onset of FT1DM may be attributed to certain HLA subtype, to viral infection, or to pregnancy (Imagawa et al, 2003;Imagawa et al, 2005;Shimizu et al, 2006;Kawabata et al, 2009). In recent study, macrophages and T cells -but not natural killer cells -had infiltrated the islets and the exocrine pancreas and Toll-like receptor (TLR) 3, a sensor of viral components, was detected in most of macrophages and T cells in FT1DM patients (Shibasaki et al, 2010).…”

Section: Onset Of Fulminant Type 1 Diabetes Mellitusmentioning

confidence: 99%