Clinical characteristics of Chinese patients with fulminant type 1 diabetes mellitus: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YANG Zhongce ¹ , DONG Lintao ¹ , PAN Li ¹ , JIN Hongxiu ¹ , ZHANG Jingrong ¹ , LI Lan ² , BI Hongyan ¹ ,  LUO Jingmei ¹ ,  ZHANG Lihua ¹

1. Department of General Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;
2. Department of Diabetes Mellitus, The First Affiliated Hospital of Kunming Medical University, Kunming 650031, P. R. China;

Corresponding?author：

LUO Jingmei, Email: 185349239@qq.com; ZHANG Lihua, Email: lihuazhang772002@163.com

Keywords：

China; Fulminant type 1 diabetes mellitus; Clinical characteristics; Meta-analysis

DOI：

10.7507/1672-2531.202202068

Video：

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Objective To systematically review the prevalence, clinical characteristics, and prognosis of fulminant type 1 diabetes mellitus (F1DM) in China. Methods The CNKI, WanFang Data, CBM and PubMed databases were searched to collect Chinese F1MD case reports from January 1, 2000 to March 30, 2022. Data analysis was performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 874 cases were included in 233 papers, involving 410 males (46.91%) and 464 females (53.09%). The age of onset was 29.32±1.09 years and the course of disease was 3.74±0.63 days. The BMI was 21.18±0.52 kg/m², HbA1c was 6.58%±0.08%, the level of fasting C-peptide was 0.04±0.010 ng/mL, level of C-peptide 2 h after meal was 0.09±0.020 ng/mL, the level of blood glucose at the doctor’s office was 34.72±2.89 mmol/L, and the level of arterial blood gas pH was 7.09±0.015. Among them, 734 patients had diabetic ketoacidosis (84.55%), 496 patients had infection of the upper respiratory or digestive tract before onset (56.75%), 4 patients died (0.46%), 78 patients were GADA positive, 11 patients were ICA positive, 13 patients were IAA positive, and 109 were pregnant patients (90 fetal deaths, 82.57%). Conclusion Chinese F1DM is a special but common subtype of diabetes. Its characteristics include a relatively young age of onset, devastating islet damage, and rapid progression, and it is often accompanied by severe metabolic disorders, complications, and grim prognosis. Clinicians should pay more attention to F1DM.

Citation： YANG Zhongce, DONG Lintao, PAN Li, JIN Hongxiu, ZHANG Jingrong, LI Lan, BI Hongyan, LUO Jingmei, ZHANG Lihua. Clinical characteristics of Chinese patients with fulminant type 1 diabetes mellitus: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(8): 891-895. doi: 10.7507/1672-2531.202202068 Copy

1.	Imagawa A, Hanafusa T, Miyagawa J, et al. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. Osaka IDDM Study Group. N Engl J Med, 2000, 342(5): 301-307.
2.	Imagawa A, Hanafusa T, Iwahashi H, et al. Uniformity in clinical and HLA-DR status regardless of age and gender within fulminant type 1 diabetes. Diabetes Res Clin Pract, 2008, 82(2): 233-237.
3.	Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the research of fulminant and acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). J Diabetes Investig, 2012, 3(6): 536-539.
4.	王曉晶, 王彤, 于淼, 等. 12例暴發性1型糖尿病臨床特征分析. 中國糖尿病雜志, 2018, 26(1): 69-73.
5.	王柏榮, 陸志強, 李曉牧, 等. 新發暴發型1型糖尿病中糖化白蛋白/HbA1C比值與血糖波動幅度的相關性研究. 中華內分泌代謝雜志, 2017, 33(4): 326-329.
6.	Ying L, Ma X, Lu J, et al. Fulminant type 1 diabetes: the clinical and continuous glucose monitoring characteristics in Chinese patients. Clin Exp Pharmacol Physiol, 2019, 46(9): 806-812.
7.	Wang J, Liu BL, Li Z, et al. The characteristics of blood glucose fluctuations in patients with fulminant type 1 diabetes mellitus in the stable stage. Arch Endocrinol Metab, 2018, 62(6): 585-590.
8.	朱文華, 鐘紹, 潘穎, 等. 暴發性1型糖尿病7例診治分析. 內科急危重癥雜志, 2017, 23(5): 413-414.
9.	孫致連, 李紅暉, 唐平, 等. 暴發性1型糖尿病的臨床研究. 廣東醫學, 2016, 37(z2): 57-58.
10.	謝新榮, 鐘慕賢, 黃普好. 新發暴發性1型糖尿病與經典1型糖尿病及成人隱匿性自身免疫性糖尿病的臨床特征比較. 中國糖尿病雜志, 2021, 29(10): 754-757.
11.	王毅, 鞏純秀, 曹冰燕, 等. 兒童與青少年暴發性1型糖尿病與經典1型糖尿病的區別. 中華實用兒科臨床雜志, 2015, 30(8): 580-584.
12.	Yang D, Zhou Y, Luo S, et al. Clinical characteristics of fulminant type 1 diabetes compared with typical type 1 diabetes: one-year follow-up study from the Guangdong T1DM Translational Medicine Study. J Diabetes Res, 2020, 2020: 8726268.
13.	Moreau C, Drui D, Arnault-Ouary G, et al. Fulminant type 1 diabetes in Caucasian: a report of three cases. Diabetes Metab, 2008, 34(5): 529-532.
14.	張弛, 周智廣, 張冬梅, 等. 急驟起病伴胰酶增高的1型糖尿病臨床和免疫學特征. 中華醫學雜志, 2005, 85(14): 967-971.
15.	Luo S, Zhang Z, Li X, et al. Fulminant type 1 diabetes: a collaborative clinical cases investigation in China. Acta Diabetol, 2013, 50(1): 53-59.
16.	Shimizu I, Makino H, Imagawa A, et al. Clinical and immunogenetic characteristics of fulminant type 1 diabetes associated with pregnancy. J Clin Endocrinol Metab, 2006, 91(2): 471-476.
17.	Liu L, Mao J, Lu Z, et al. Clinical characteristics of fulminant type 1 diabetes associated with pregnancy in China. Endocrine, 2011, 40(3): 408-412.
18.	王娜, 李曉赟, 許永良. 妊娠相關性暴發性1型糖尿病與經典1型糖尿病的對比. 浙江實用醫學, 2019, 24(1): 28-29,62.
19.	Matsuura N, Yoshino S, Morisaki H. A case of fulminant type 1 diabetes masquerading acute pancreatitis. J Gen Fam Med, 2017, 18(1): 32-34.
20.	Liu L, Zeng L, Sang D, et al. Recent findings on fulminant type 1 diabetes. Diabetes Metab Res Rev, 2018, 34(1).
21.	Hosokawa Y, Hanafusa T, Imagawa A. Pathogenesis of fulminant type 1 diabetes: genes, viruses and the immune mechanism, and usefulness of patient-derived induced pluripotent stem cells for future research. J Diabetes Investig, 2019, 10(5): 1158-1164.
22.	吳晗, 方興宇, 于淼, 等. 單中心22例暴發性1型糖尿病臨床特征分析. 中華糖尿病雜志, 2018, 10(9): 590-595.
23.	Liu L, Jia W, Wu Y, et al. Plasma glucose to glycated hemoglobin ratio: method of differentiating fulminant type 1 diabetes from diabetic ketoacidosis. Ann Endocrinol (Paris), 2019, 80(1): 16-20.

1. Imagawa A, Hanafusa T, Miyagawa J, et al. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. Osaka IDDM Study Group. N Engl J Med, 2000, 342(5): 301-307.
2. Imagawa A, Hanafusa T, Iwahashi H, et al. Uniformity in clinical and HLA-DR status regardless of age and gender within fulminant type 1 diabetes. Diabetes Res Clin Pract, 2008, 82(2): 233-237.
3. Imagawa A, Hanafusa T, Awata T, et al. Report of the Committee of the Japan Diabetes Society on the research of fulminant and acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). J Diabetes Investig, 2012, 3(6): 536-539.
4. 王曉晶, 王彤, 于淼, 等. 12例暴發性1型糖尿病臨床特征分析. 中國糖尿病雜志, 2018, 26(1): 69-73.
5. 王柏榮, 陸志強, 李曉牧, 等. 新發暴發型1型糖尿病中糖化白蛋白/HbA1C比值與血糖波動幅度的相關性研究. 中華內分泌代謝雜志, 2017, 33(4): 326-329.
6. Ying L, Ma X, Lu J, et al. Fulminant type 1 diabetes: the clinical and continuous glucose monitoring characteristics in Chinese patients. Clin Exp Pharmacol Physiol, 2019, 46(9): 806-812.
7. Wang J, Liu BL, Li Z, et al. The characteristics of blood glucose fluctuations in patients with fulminant type 1 diabetes mellitus in the stable stage. Arch Endocrinol Metab, 2018, 62(6): 585-590.
8. 朱文華, 鐘紹, 潘穎, 等. 暴發性1型糖尿病7例診治分析. 內科急危重癥雜志, 2017, 23(5): 413-414.
9. 孫致連, 李紅暉, 唐平, 等. 暴發性1型糖尿病的臨床研究. 廣東醫學, 2016, 37(z2): 57-58.
10. 謝新榮, 鐘慕賢, 黃普好. 新發暴發性1型糖尿病與經典1型糖尿病及成人隱匿性自身免疫性糖尿病的臨床特征比較. 中國糖尿病雜志, 2021, 29(10): 754-757.
11. 王毅, 鞏純秀, 曹冰燕, 等. 兒童與青少年暴發性1型糖尿病與經典1型糖尿病的區別. 中華實用兒科臨床雜志, 2015, 30(8): 580-584.
12. Yang D, Zhou Y, Luo S, et al. Clinical characteristics of fulminant type 1 diabetes compared with typical type 1 diabetes: one-year follow-up study from the Guangdong T1DM Translational Medicine Study. J Diabetes Res, 2020, 2020: 8726268.
13. Moreau C, Drui D, Arnault-Ouary G, et al. Fulminant type 1 diabetes in Caucasian: a report of three cases. Diabetes Metab, 2008, 34(5): 529-532.
14. 張弛, 周智廣, 張冬梅, 等. 急驟起病伴胰酶增高的1型糖尿病臨床和免疫學特征. 中華醫學雜志, 2005, 85(14): 967-971.
15. Luo S, Zhang Z, Li X, et al. Fulminant type 1 diabetes: a collaborative clinical cases investigation in China. Acta Diabetol, 2013, 50(1): 53-59.
16. Shimizu I, Makino H, Imagawa A, et al. Clinical and immunogenetic characteristics of fulminant type 1 diabetes associated with pregnancy. J Clin Endocrinol Metab, 2006, 91(2): 471-476.
17. Liu L, Mao J, Lu Z, et al. Clinical characteristics of fulminant type 1 diabetes associated with pregnancy in China. Endocrine, 2011, 40(3): 408-412.
18. 王娜, 李曉赟, 許永良. 妊娠相關性暴發性1型糖尿病與經典1型糖尿病的對比. 浙江實用醫學, 2019, 24(1): 28-29,62.
19. Matsuura N, Yoshino S, Morisaki H. A case of fulminant type 1 diabetes masquerading acute pancreatitis. J Gen Fam Med, 2017, 18(1): 32-34.
20. Liu L, Zeng L, Sang D, et al. Recent findings on fulminant type 1 diabetes. Diabetes Metab Res Rev, 2018, 34(1).
21. Hosokawa Y, Hanafusa T, Imagawa A. Pathogenesis of fulminant type 1 diabetes: genes, viruses and the immune mechanism, and usefulness of patient-derived induced pluripotent stem cells for future research. J Diabetes Investig, 2019, 10(5): 1158-1164.
22. 吳晗, 方興宇, 于淼, 等. 單中心22例暴發性1型糖尿病臨床特征分析. 中華糖尿病雜志, 2018, 10(9): 590-595.
23. Liu L, Jia W, Wu Y, et al. Plasma glucose to glycated hemoglobin ratio: method of differentiating fulminant type 1 diabetes from diabetic ketoacidosis. Ann Endocrinol (Paris), 2019, 80(1): 16-20.

Chinese Journal of Evidence-Based Medicine

Clinical characteristics of Chinese patients with fulminant type 1 diabetes mellitus: a meta-analysis

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