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Diabetology International

, Volume 7, Issue 3, pp 281–288 | Cite as

Risk factors for sudden death and cardiac arrest at the onset of fulminant type 1 diabetes mellitus

  • Megu Yamaguchi Baden
  • Akihisa Imagawa
  • Hiromi Iwahashi
  • Iichiro Shimomura
  • Takuya Awata
  • Hiroshi Ikegami
  • Yasuko Uchigata
  • Haruhiko Osawa
  • Hiroshi Kajio
  • Eiji Kawasaki
  • Yumiko Kawabata
  • Akira Shimada
  • Kazuma Takahashi
  • Shoichiro Tanaka
  • Kazuki Yasuda
  • Hisafumi Yasuda
  • Tetsuro Kobayashi
  • Toshiaki Hanafusa
Original Article

Abstract

Aims

The onset of fulminant type 1 diabetes mellitus is sometimes accompanied by sudden death or cardiac arrest. The aim of this study was to determine the risk factors for the development of these conditions at the onset of fulminant type 1 diabetes mellitus.

Methods

We conducted a search of the literature on fulminant type 1 diabetes and sudden death or cardiac arrest published up to 2012 in PubMed and Ichushi (a Japanese article database), and a questionnaire survey was administered to the authors of the articles and to diabetes specialists affiliated to the Japan Diabetes Society. We analyzed the clinical data at disease onset of 17 patients with fulminant type 1 diabetes mellitus who experienced sudden death or cardiac arrest, and those of 257 patients who did not develop these conditions.

Results

Patients with sudden death or cardiac arrest were younger, had a higher rate of impaired consciousness, more severe acidosis, hyperglycemia, hyponatremia, hyperkalemia, and hypochloremia, a higher serum blood urea nitrogen level, a higher serum creatinine level, and a higher plasma osmolality level than the other patients. In multiple logistic regression analyses, plasma glucose level was positively associated with sudden death or cardiac arrest. Receiver operating characteristic curve analyses showed that patients with a plasma glucose level over 1000 mg/dl (55.5 mmol/l) were at a high risk of cardiac arrest.

Conclusions

Severe metabolic derangement, especially a high plasma glucose level, is associated with sudden death or cardiac arrest at the onset of fulminant type 1 diabetes mellitus.

Keywords

Fulminant type 1 diabetes mellitus Sudden death Cardiac arrest Risk factors 

Notes

Acknowledgments

The other member of the Japan Diabetes Society Committee on Type 1 Diabetes Mellitus Research is Seiho Nagafuchi (Department of Medical Science and Technology, Graduate School of Medical Sciences, Kyushu University). The authors express their sincere gratitude to Dr. Kazuro Kaise, Dr. Satsuki Niitsuma, Dr. Ayako Ro, Dr. Kazuaki Shinohara, and all diabetes specialists affiliated to the Japan Diabetes Society for answering the questionnaire.

Compliance with ethical standards

Conflict of interest statement

Toshiaki Hanafusa received honoraria for lectures from Ono Pharmaceutical, Mitsubishi Tanabe Pharma, and Sumitomo Dainippon Pharma. Hiroshi Ikegami received honoraria for lectures from Novo Nordisk Pharmaceuticals Industries, Inc., Sumitomo Dainippon Pharma, and Kowa Company, and scholarship grants from Ono Pharmaceutical and Novo Nordisk Pharmaceuticals Industries, Inc. Yumiko Kawabata received scholarship grants from Ono Pharmaceutical and Novo Nordisk Pharmaceuticals Industries, Inc. Other authors declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for it was obtained from all patients before they were included in the study.

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Copyright information

© The Japan Diabetes Society 2015

Authors and Affiliations

  • Megu Yamaguchi Baden
    • 1
  • Akihisa Imagawa
    • 1
  • Hiromi Iwahashi
    • 1
  • Iichiro Shimomura
    • 1
  • Takuya Awata
    • 2
  • Hiroshi Ikegami
    • 3
  • Yasuko Uchigata
    • 4
  • Haruhiko Osawa
    • 5
  • Hiroshi Kajio
    • 6
  • Eiji Kawasaki
    • 7
    • 8
  • Yumiko Kawabata
    • 3
  • Akira Shimada
    • 9
  • Kazuma Takahashi
    • 10
  • Shoichiro Tanaka
    • 11
  • Kazuki Yasuda
    • 12
  • Hisafumi Yasuda
    • 13
  • Tetsuro Kobayashi
    • 14
  • Toshiaki Hanafusa
    • 15
  1. 1.Department of Metabolic Medicine, Graduate School of MedicineOsaka UniversitySuitaJapan
  2. 2.Department of Diabetes, Endocrinology and MetabolismInternational University of Health and Welfare HospitalTochigiJapan
  3. 3.Department of Endocrinology, Metabolism and DiabetesKinki University Faculty of MedicineOsakaJapan
  4. 4.Diabetes CenterTokyo Women’s Medical University School of MedicineTokyoJapan
  5. 5.Department of Laboratory MedicineEhime University School of MedicineEhimeJapan
  6. 6.Department of Diabetes, Endocrinology, and Metabolism, Center HospitalNational Center for Global Health and MedicineTokyoJapan
  7. 7.Department of Endocrinology and MetabolismNagasaki University HospitalNagasakiJapan
  8. 8.Department of Diabetes and EndocrinologyShin-Koga HospitalKurumeJapan
  9. 9.Department of Internal MedicineSaiseikai Central HospitalTokyoJapan
  10. 10.Department of Diabetes and MetabolismIwate Medical UniversityIwateJapan
  11. 11.Third Department of Internal MedicineUniversity of YamanashiYamanashiJapan
  12. 12.Department of Metabolic Disorder, Diabetes Research CenterResearch Institute, National Center for Global Health and MedicineTokyoJapan
  13. 13.Division of Health Sciences, Department of Community Health SciencesKobe University Graduate School of Health SciencesKobeJapan
  14. 14.Okinaka Memorial Institute for Medical ResearchTokyoJapan
  15. 15.Department of Internal Medicine (I)Osaka Medical CollegeTakatsukiJapan

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