2019 Volume 62 Issue 4 Pages 214-219
Acute-onset type 1 diabetes is a subtype of type 1 diabetes in which the process of beta cell destruction and subsequent hyperglycemia and ketoacidosis develop within approximately 3 months. Acute-onset type 1 diabetes patients are positive for at least one of islet cell autoantibodies. A 67-year-old Japanese man who had shown an HbA1c value of 5.7 % two months previously developed polyuria, polydipsia, and appetite loss two days after a seasonal influenza vaccination and lost 6 kg body weight during the initial week after the vaccination. His serum levels of pancreatic exocrine enzymes were elevated. The patient was negative for serum glutamic acid decarboxylase (GAD) antibody, insulinoma-associated antigen-2 (IA-2) antibody and insulin antibody, but positive for zinc transporter 8 (ZnT8) antibody (22.8 U/mL). HLA phenotyping revealed the specific HLA haplotype (DQB1*06:01:01- DQB1*06:02:01), which was previously found to be negatively associated with acute-onset type 1 diabetes. Despite the abrupt onset of hyperglycemia mimicking fulminant type 1 diabetes, he did not ultimately progress into complete impairment of insulin secretion and it was also atypical as acute-onset type 1 diabetes. A seasonal influenza vaccination may have triggered the development of autoimmune type 1 diabetes.
