Fulminant type 1 diabetes - A nationwide survey in Japan

被引:250
作者
Imagawa, A
Hanafusa, T
Uchigata, Y
Kanatsuka, A
Kawasaki, E
Kobayashi, T
Shimada, A
Shimizu, I
Toyoda, T
Maruyama, T
Makino, H
机构
[1] Osaka Med Coll, Dept Internal Med 1, Takatsuki, Osaka 5698686, Japan
[2] Osaka Univ, Grad Sch Med, Dept Internal Med & Mol Sci, Suita, Osaka, Japan
[3] Tokyo Womens Med Univ Sch Med, Ctr Diabet, Tokyo, Japan
[4] Kasori Hosp, Ctr Diabet, Chiba, Japan
[5] Nagasaki Univ, Sch Med, Unit Metab Diabet & Clin Nutr, Nagasaki 852, Japan
[6] Univ Yamanashi, Sch Med, Dept Internal Med 3, Nakakoma, Japan
[7] Keio Univ, Sch Med, Dept Internal Med, Tokyo, Japan
[8] Ehime Prefectural Cent Hosp, Matsuyama, Ehime, Japan
[9] Kurume Univ, Sch Med, Dept Virol, Kurume, Fukuoka 830, Japan
[10] Saitama Social Insurance Hosp, Dept Internal Med, Urawa, Saitama, Japan
[11] Ehime Univ, Sch Med, Dept Lab Med, Matsuyama, Ehime 790, Japan
关键词
D O I
10.2337/diacare.26.8.2345
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE - To describe the clinical and immunologic characteristics of fulminant type I diabetes, a novel subtype of type I diabetes, we conducted a nationwide survey. RESEARCH DESIGN AND METHODS - History and laboratory data, including islet-related autoantibodies, were examined in 222 patients with fulminant and nonfulminant type I diabetes in our hospitals in addition to another 118 patients with fulminant type I diabetes located outside our hospitals in Japan. RESULTS - in our hospitals, of the 222 patients studied, 43 (19.4%) were diagnosed with fulminant type 1 diabetes, 137 (61.7%) were classified as having autoimmune type I diabetes, and 42 were type I diabetic subjects who were not fulminant and did not have anti-islet antibodies. An additional 118 fulminant patients outside our hospitals were enrolled, making a total of 161 fulminant type I diabetic subjects (83 male and 78 female subjects; 14 children/adolescents and 147 adults) identified from all over Japan. (In 2000, the average incidence was three cases per month.) Flu-like symptoms and pregnancy were more frequently observed in the fulminant than in the autoimmune group (P < 0.001). In the fulminant patients, 4.8% were positive for anti-GAD antibodies and none were positive for anti-islet antigen 2 antibodies. CONCLUSIONS - Fulminant type I diabetes is a distinct subtype and accounts for ∼20% Of the ketosis-onset type I diabetes cases in Japan. Flu-like symptoms are characteristic of disease onset. Metabolic derangement is more severe in this subtype than in autoimmune type I diabetes.
引用
收藏
页码:2345 / 2352
页数:8
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