A follow-up study of fulminant type 1 diabetes mellitus

Objectives: To explore the possible mechanisms of glycol-metabolism and islet function in patients with fulminant type 1 diabetes (FT1DM). Methods: A follow-up study was conducted on 13 patients with FT1DM from September 2000 to March 2018. Patient general clinical data were collected and analyzed. The gene sequences of Human leukocyte antigen (HLA)-DRB1, HLA-DQA1 and HLA-DQB1 were analyzed by polymerase chain reaction (PCR). Results: Compared with baseline, the waist-hip ratio was significantly increased at follow-up (P<0.05). Compared with baseline, HbA1c significantly increased; C-P0 and C-P120 significantly decreased, and the differences were statistically significant (P<0.05). Compared with baseline, White blood cell count (WBC), aspartate aminotransferase (AST), serum potassium (K), creatinine (Cr), glutamyl transpeptidase (GGT), creatine kinase (CK), alkalinity phospholipase (AKP) decreased significantly (P<0.05), while cholesterol (TC) and high-density lipoprotein (HDL) increased significantly (P<0.05). Viral antibody was detected in 13 cases of FT1DM: Coxsackie viral antibody was positive in 2 cases and herpes simplex viral antibody was positive in 3 cases. Gene detection: The higher frequency of HLA-DRB1 allele was DRB1*0301 (88.9%), DRB1*07 (44.4%), and the higher frequency of HLA-DQA1 allele was DQA1*0104 (55.6%), DQA1*0103 (44.4%), and the higher frequencies of HLA-DQB1 allele were DQB1*0201 (50.0%), DQB1*0502 (33.3%), and DQB1*0301 (25.0%). Conclusions: Although the β-cell function of FT1DM was progressively irreversibly destroyed with the progression of the disease, metabolic disorders and stress responses were relieved at the later stage. Viral infections (herpes simplex virus, Coxsackie virus), HLA-DQ, DR genes, GAD-Ab and other related antibodies may be involved in the occurrence of FT1DM.