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Fulminant type 1 diabetes: a collaborative clinical cases investigation in China

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Abstract

To clarify the detailed distribution, clinical and immunological features of patients with fulminant type 1 diabetes (F1D), we consecutively investigated 53 cases from nationwide 24 hospitals in China. After the clinical and immunological features were evaluated, we compared pregnancy-associated F1D (PF) with those of child-bearing age with F1D that was not associated with pregnancy in clinical characteristics. As a result, patients with F1D were reported from all over China, and there was no significant regional and seasonal preference of this disease. Around 34.0% (18/53) patients displayed low titers of autoantibodies against one or more autoantigens, including 12 cases positive for GADA, 2 for IA-2A, 4 for ZnT8A and 3 for both GADA and ZnT8A. The frequency of PF in female F1D was 34.6% (9/26). Among 9 PF patients, 8 (88.9%) developed F1D during pregnancy which resulted in stillbirth, while one had the onset of F1D after eutocia with her fetus survived. This study suggests that islet-associated autoimmunity may be involved in and contribute to the development of F1D. Pregnant women may be PF high-risk population, and the prognosis for the fetus is extremely poor in PF patients.

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Abbreviations

F1D:

Fulminant type 1 diabetes

PF:

Pregnancy-associated fulminant type 1 diabetes

NPF:

Fulminant type 1 diabetes that was not associated with pregnancy

ICA:

Autoantibodies against islet cells

GADA:

Autoantibodies against glutamic acid decarboxylase

IA-2A:

Protein tyrosine phosphatase autoantibodies

ZnT8A:

Zinc transporter 8 autoantibodies

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Acknowledgments

This study was supported by the National Natural Science Foundation of China (Grant No. 30670991, 81070672, 81000316), Aid Program for Science and Technology Innovative Research Team in Higher Educational Institutions of Hunan Province, the National Department Public Benefit (Health) Research Foundation of China (Grant No. 201002002), the Doctoral Fund of Ministry of Education (Grant No. 200805330055), the Special Research Foundation of Young teachers (Grant No. 200805331018). We greatly acknowledge Dr. Jennifer Skidmore (Pacific Northwest Diabetes Research Institute, Seattle, WA 98040, USA) and Dr. Zhijie Dai, Dr. Yufei Xiang, Dr. Anping Wang (Diabetes Center, Central South University, Changsha 410011, China) for the skillful revision of this article. We would like to thank the following doctors and hospitals who referred the patients to this survey: Xinhua Xiao, Xiaofang Sun, Peking Union Medical College Hospital; Hong Liu, The First Affiliated Hospital of Guangxi Medical University; Song Zhang, The Affiliated Hospital of Guiyang Medical College; Xiaohong Lin, The First Hospital of Hunan Zhuzhou; Fang Wen, The First Affiliated Hospital of Nanhua University; Jianping Wang, The Second Affiliated Hospital of Nanhua University; Dalong Zhu, Lirong Li, Nanjing Drum Tower Hospital of Nanjing University; Xiaoling Wang, The Beilun People’s Hospital of Zhejiang Ninbo; Dawang Wang, The First Affiliated Hospital of Wenzhou Medical College; Hongying Ye, Huashan Hospital Fudan University; Yanhua Zhu, Xubin Yang, The Third Affiliated Hospital of Zhongshan University; Bingyin Shi, Jiao Fu, The First Affiliated Hospital of Medical College of Xian Jiaotong University; Zeyuan Lu, the Forth People’s (Futian) Hospital of Shenzhen; Yi Zhang, Quanzhou Hospital of Hujian Medical University; Lin Qian, Yanling Zhu, Oriental Company Central Hospital of PetroChina; Xuefang Liu, Liankun Zen, Boji Hospital of Zhongshan University; Jiancang Zhou, Sir Run Run Shaw Hospital, Medical School of Zhejiang University; Yuehong Zhou, Min Liu, Liu Yang Chinese Medicine Hospital of Hunan.

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Authors and Affiliations

  1. Diabetes Center, Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, 139 Renmin Zhong Road, Changsha, 410011, China

    Shuoming Luo, Zhenyi Zhang, Xia Li, Lin Yang, Jian Lin, Xiang Yan, Zhen Wang, Chao Zheng, Gan Huang & Zhiguang Zhou

  2. Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, 139 Renmin Zhong Road, Changsha, 410011, China

    Shuoming Luo, Zhenyi Zhang, Xia Li, Lin Yang, Jian Lin, Xiang Yan, Zhen Wang, Chao Zheng, Gan Huang & Zhiguang Zhou

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  1. Shuoming Luo
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  2. Zhenyi Zhang
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  3. Xia Li
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  4. Lin Yang
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  5. Jian Lin
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  6. Xiang Yan
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  7. Zhen Wang
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  8. Chao Zheng
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  9. Gan Huang
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  10. Zhiguang Zhou
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Correspondence to Zhiguang Zhou.

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Shuoming Luo and Zhenyi Zhang contributed equally to this work.

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Luo, S., Zhang, Z., Li, X. et al. Fulminant type 1 diabetes: a collaborative clinical cases investigation in China. Acta Diabetol 50, 53–59 (2013). https://doi.org/10.1007/s00592-011-0362-1

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  • DOI: https://doi.org/10.1007/s00592-011-0362-1

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