Clinical Characteristics of Cases that Progress Rapidly from Type 2 Diabetes to Insulin Deficiency Such as Fulminant Type 1 Diabetes: Subcommittee Report on Fulminant and Acute Type 1 Diabetes, Committee on Type 1 Diabetes, Japan Diabetes Society

Abstract

We performed a national survey of cases that had progressed rapidly from type 2 diabetes to insulin deficiency such as fulminant type 1 diabetes, and analyzed clinical case characteristics. We found that, compared to classical fulminant type 1 diabetes, subjects in these cases were relatively older at disease onset and had a higher body mass index (BMI), a higher rate of consciousness disturbance, a higher level of HbA1c, a lower level of arterial blood pH, and a lower level of urine C-peptide (CPR). We also found that BMI was significantly higher in cases with consciousness disturbance than in cases without. Due to their severe clinical course, it is very important that these cases be diagnosed, although 27.8 % of the cases surveyed did not comply with current diagnostic criteria for fulminant type 1 diabetes. We suggest that a combination of changes in markers such as low serum and urine CPR levels, short-term HbA1c elevation, and increases in serum pancreas exocrine enzymes, such as elastase-1 and lipase, may be useful for diagnosing these cases.