Fulminant Type 1 Diabetes Particularly Severe in Pregnancy

The clinical symptoms of pregnancy-associated fulminant type 1 diabetes appear to be much more serious than those experienced by comparable women with fulminant type 1 diabetes that is not associated with pregnancy, according to researchers.

Dr. Hideichi Makino of Ehime University School of Medicine and colleagues note that fulminant type 1 diabetes is recognized in Japan as a novel subtype of type 1B diabetes — that is, idiopathic and not immune mediated.

The condition is characterized by abrupt onset, very short duration of diabetic symptoms, acidosis at diagnosis, and absent islet-related autoantibodies. Little information, the investigators say, is available on the occurrence of this condition in Western countries.

To better characterize the situation in Japan, the researchers studied data on 22 women with pregnancy-associated fulminant type 1 diabetes (PF). Eighteen developed the disease during pregnancy and the remaining four did so within 2 weeks of delivery. Overall, there were only 6 live births and 5 were delivered by cesarean section.

These women were compared with 48 patients with fulminant type 1 diabetes not associated with pregnancy (NPF). Arterial pH and HBa1c levels were significantly lower in the PF than NPF patients at disease onset. They also tended to have higher serum amylase levels.

The researchers also found that the distribution of HLA class II haplotypes were distinctly different between groups despite being almost the same phenotype.

In addition, Dr. Makino and colleagues note that viral infection is "strongly suggested" in both groups, because of the observation of frequent flu-like symptoms and a seasonal variation in onset.

Regardless of the cause, the investigators conclude, PF in particular "needs to be recognized by all medical staffs because of the abrupt onset during pregnancy or immediately after delivery and the poor prognosis of the resulting fetus."
J Clin Endocrinol Metab 2006;91:471-476.

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DID YOU KNOW:
Diabetes Was Developed in Fish: Indian scientists have succeeded in inducing the most prevalent type 2 diabetes in a freshwater fish, which could turn out to be a convenient animal model to treat the disease.The disease, which accounts for 95 per cent cases of the disorder, was induced by feeding the Indian perch (Anabas testudineus) with a compound called palmitate. This compound belongs to a class called free fatty acid, which is among the major reasons for development of diabetes. Palmitate intake for a prolonged period of 100 days increased the body weight of the animal by more than 60 per cent. Glucose and insulin levels were also elevated more than 2.5 fold in the same time period. Scientists also found development of insulin resistance, an indicator of type 2 diabetes. Prof Anoop Misra, a diabetologist from the All India Institute of Medical Sciences, said the animal could be used in the future for studying new compounds. Current Science, March 2006, Visva-Bharati, Santiniketan