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Clin Exp Pharmacol Physiol. 2019 May 3. doi: 10.1111/1440-1681.13099. [Epub ahead of print]

Fulminant Type 1 Diabetes: The Clinical and Continuous Glucose Monitoring Characteristics in Chinese Patients.

Author information

1
Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
2
Diabetes Institute of the Walter REED National Military Medical Center, Bethesdo, MD, 20889.
3
Medtronic Diabetes, Northridge, CA, 91325.

Abstract

The purpose of the current study was to investigate the clinical characteristics of fulminant type 1 diabetes mellitus (FT1DM) in Chinese patients and to further determine their glycemic profiles through continuous glucose monitoring (CGM). Thirty subjects who were diagnosed with FT1DM according to the 2012 JDS criteria were enrolled. Clinical characteristics were compared to those reported in Japanese FT1DM. All subjects received retrospective CGM for 3 days after being converted to subcutaneous insulin injection therapy. Chinese FT1DM patients presented with a shorter duration of symptoms (2.84±2.42 days vs. 4.4±3.1 days, P<0.01), worse islet function (fasting C-peptide, 0.09±0.11 ng/mL vs. 0.30±0.21 ng/mL; 2-hour C-peptide, 0.13±0.14 ng/mL vs. 0.30±0.30 ng/mL, both P<0.01), lower prevalence of flu-like symptoms (46.7% vs. 71.4%, P<0.05), and a significantly higher GADA positive rate (23.3% vs. 5.1%, P<0.01) when compared with Japanese patients. The CGM results showed that the mean time in range (TIR) of FT1DM patients was 49.8±22.1%, while mean amplitude of glycemic excursion (MAGE) and standard deviations of sensor glucose (SDSG) were 7.58±3.59 mmol/L and 3.19±1.22 mmol/L, respectively, with nearly 1/3 participants coefficient of variation (CV)>36% (all are male), suggesting a large glucose fluctuation. The female patients were further divided into pregnancy-related FT1DM (PF) and non-PF (NPF) subgroups (both n=5), and we found that PF patients had a significantly higher TIR than NPF patients (77.0±16.1% vs. 41.0±22.4%, P<0.05). There were heterogeneities in the clinical characteristics of FT1DM patients, and the CGM results indicated a very low TIR and large glucose fluctuation which needs careful attention. This article is protected by copyright. All rights reserved.

KEYWORDS:

Continuous glucose monitoring; Fulminant type 1 diabetes mellitus; Glucose fluctuation; Time in range

PMID:
31050819
DOI:
10.1111/1440-1681.13099

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