title: Fulminant type 1 diabetes mellitus exhibits distinct clinical and autoimmunity features from classical type 1 diabetes mellitus in Chinese.
abstract: BACKGROUND
  fulminant type 1 diabetes mellitus (T1DM) is characterized by abrupt onset of hyperglycemia and rapid progression to ketoacidosis. This study aimed at examining the clinical and autoimmunity features of fulminant T1DM in Chinese.
  
  
  METHODS
  a total of 24 patients with fulminant T1DM and 48 classical autoimmune T1DM patients with acute onset of ketoacidosis were recruited. Anthropometric and biochemical parameters were tested. Serum antibodies against glutamic acid decarboxylase 65, tyrosine phosphatase-2 and zinc transporter 8 were measured, and human leukocyte antigen-DQ haplotypes were determined. Peripheral glutamic acid decarboxylase 65-specific T-cell responses in some subjects were determined.
  
  
  RESULTS
  compared with autoimmune T1DM patients, patients with fulminant T1DM displayed more flu-like and gastrointestinal symptoms, and had significantly higher concentrations of plasma glucose, more severe ketoacidosis, very low levels of pancreatic β-cell reserve, but only slightly increased haemoglobin A(1c) levels. In some patients, the disease onset was associated with drug-related hypersensitivity, pregnancy, or positive serum IgM against viruses. Forty percent (8/20) had low titres of autoantibodies against at least one of the islet autoantigens tested. Three out of six patients had positive glutamic acid decarboxylase-reactive Th1 responses. The frequency of human leukocyte antigen -DQA1*0102-DQB1*0601 haplotype was significantly higher in patients with fulminant T1DM.
  
  
  CONCLUSIONS
  fulminant T1DM is a distinct entity with unique clinical characteristics and may be mediated by multiple factors, including viral infection, pregnancy, and drug sensitivity syndrome, among others, in the presence of humoral and/or cellular autoimmunity and susceptible genetic background.
authors.affiliation: Diabetes Center and Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zheng
authors.forename: Zhiguang
authors.initials: Z
authors.lastname: Zhou
authors.forename: Lin
authors.initials: L
authors.lastname: Yang
authors.forename: Jian
authors.initials: J
authors.lastname: Lin
authors.forename: Gan
authors.initials: G
authors.lastname: Huang
authors.forename: Xia
authors.initials: X
authors.lastname: Li
authors.forename: Weidong
authors.initials: W
authors.lastname: Zhou
authors.forename: Xiangbing
authors.initials: X
authors.lastname: Wang
authors.forename: Zhenqi
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People / Q000235:genetics; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D015551:Autoimmunity; D027682:Cation Transport Proteins / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000235:genetics / Q000276:immunology*; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000235:genetics / Q000276:immunology*; D004342:Drug Hypersensitivity; D005260:Female; D005968:Glutamate Decarboxylase / Q000097:blood; D006683:HLA-DQ Antigens / Q000235:genetics / Q000276:immunology; D006239:Haplotypes / Q000235:genetics; D006801:Humans; D007515:Islets of Langerhans / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D017027:Protein Tyrosine Phosphatases / Q000097:blood; D055815:Young Adult; D000075703:Zinc Transporter 8
chemical_list: D001323:Autoantibodies; D027682:Cation Transport Proteins; D006683:HLA-DQ Antigens; C492522:SLC30A8 protein, human; D000075703:Zinc Transporter 8; D017027:Protein Tyrosine Phosphatases; D005968:Glutamate Decarboxylase