Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute‐onset Type 1 Diabetes Mellitus: New diagnostic criteria of fulminant type 1 diabetes mellitus (2012)

Abstract

We have revised a part of the diagnostic criteria for fulminant type 1 diabetes. The new criteria were set both to express the essence of this disease of rapid increase of patients' blood glucose and to be highly sensitive to reduce the misdiagnosis. After analyzing the data of 382 patients with newly-diagnosed fulminant type 1 diabetes, we adopted the glycated hemoglobin (HbA 1c ) level of 8.7% (National Glycohemoglobin Standardization Program [NGSP] value). The new criterion indicates 100% of sensitivity and the best value by receiver operating characteristic curve analysis. In addition, we added a comment that 'This value (HbA 1c <8.7% in NGSP) is not applicable for patients with previously diagnosed glucose intolerance' in the new criteria and also a comment that 'Association with human leukocyte antigen DRB1*04:05-DQB1*04:01 is reported' as a related finding. We did not revise the screening criteria and the other part of the diagnostic criteria, because they are still reliable. (J Diabetes Invest

A case report of fulminant type 1 diabetes mellitus associated with drug-induced hypersensitivity syndrome in an elderly patient with coxsackie B4 virus infection and human leukocyte antigen-A24 haplotype

“…Serum amylase was increased (178 U/L; normal range 44 to 132 U/L). Although her HbA1c was elevated by PSL treatment for DIHS, we diagnosed as FT1D according to its criteria [7].…”

Diabetic Ketoacidosis Due to Type 1 Diabetes Mellitus Induced by Interferon Therapy for Chronic Hepatitis C During the Course of Hashimoto’s Thyroiditis: Case Report

“…The case at presentation partly fulfilled the diagnostic criteria of fulminant T1D, with HbA1c level <8.7%, urinary C-peptide excretion rate <10 µg/day, and fasting serum C-peptide level <0.3 ng/mL and <0.5 ng/mL post-prandium [3]. However, the duration from the onset of hyperglycemic symptoms to occurrence of DKA was about 4 weeks, which did not meet the criterion of fulminant T1D.…”

“…However, the duration from the onset of hyperglycemic symptoms to occurrence of DKA was about 4 weeks, which did not meet the criterion of fulminant T1D. Isletrelated autoantibodies, such as antibodies against GAD, islet-associated antigen 2, and insulin, are generally undetectable in fulminant T1D [3].…”

A case of idiopathic type 1 diabetes with subsequent recovery of endogenous insulin secretion despite initial diagnosis of fulminant type 1 diabetes

“…In fulminant type 1 diabetes, remarkably acute and almost complete β-cell destruction occurs and nearly no insulin secretion remains, even just after the disease onset [5]. The established diagnostic criteria include high plasma glucose with relatively low HbA1c and an extremely low serum C-peptide level at the onset [4]. The clinical course is so rapid that a delay in the diagnosis may result in patient death.…”

“…Other findings such as undetectable islet-related autoantibodies and flu-like symptoms prior to the disease onset are often seen [3,4]. In addition, elevations of serum pancreatic enzymes (amylase, lipase or elastase-1) are observed in 98% of these patients.…”