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Fulminant type 1 diabetes: 20 years of discovery and development

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Abstract

Twenty years have passed since the first article on fulminant type 1 diabetes (FT1D) was published. FT1D is characterized by an extremely rapid onset of ketoacidosis, high plasma glucose and, conversely, a near-normal glycosylated hemoglobin level. Digestive or flu-like symptoms frequently precede the onset of ketoacidosis. Patients are usually negative for islet-related autoantibodies, with near-complete destruction of pancreatic β-cells, even at the onset of disease. Massive infiltration of immunocytes (insulitis) can be seen in the islets of patients with new-onset FT1D, but this subsides within a few weeks. Early discovery and development of research on FT1D were carried out in Japan, with some reports from Korea and China. Recently, the recognition of FT1D as an immune-related adverse effect of immune-checkpoint inhibitor therapy for various malignant tumors in some patients has drawn the attention of Western countries. The discovery and successful establishment of FT1D as a disease entity was the product of three essential factors: (1) accumulated research data spanning more than 10 years; (2) fortuitous clinical observation; and (3) organization of a dedicated Japanese research committee. We anticipate that continued investigations of FT1D by a new generation of researchers will further elucidate the pathogenesis and yield new therapies.

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Acknowledgements

I would like to express my sincere thanks to the JDS for continuously supporting us by organizing the FT1D research committee. My co-committee members from 2000 to 2020 were as follows: Hideichi Makino, Tetsuro Kobayashi, Hiroshi Ikegami, Akihisa Imagawa, Akira Shimada, Eiji Kawasaki, Taro Maruyama, Yumiko Kawabata, Takuya Awata, Norio Abiru, Hiromi Iwahashi, Yasuko Uchigata, Yoichi Oikawa, Haruhiko Osawa, Hiroshi Kajio, Azuma Kanatsuka, Junji Kozawa, Ikki Shimizu, Kazuma Takahashi, Shoichiro Tanaka, Daisuke Chujo, Tetsuya Toyoda, Masao Nagata, Seiho Nagafuchi, Tomoyasu Fukui, Junnosuke Miura, Kazuki Yasuda, Hisashi Yasuda, Katsushi Tokunaga, and Nao Nishida. Without their active contributions, research on FT1D might have been crucially delayed. I also thank Michelle Kahmeyer-Gabbe, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

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Japan Diabetes Association.

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  1. Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai-City, Osaka, 593-8304, Japan

    Toshiaki Hanafusa

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Correspondence to Toshiaki Hanafusa.

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Hanafusa, T. Fulminant type 1 diabetes: 20 years of discovery and development. Diabetol Int 11, 310–314 (2020). https://doi.org/10.1007/s13340-020-00458-2

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