Fulminant T1D rare but linked to lower HbA1c

Fulminant type 1 diabetes mellitus (FT1DM) appears to be a rare occurrence, reports a new Korea study. Patients with FT1DM show lower levels of glycated haemoglobin (HbA1c).

The retrospective study included 76,309 patients who had regularly visited endocrinology outpatient clinics for >1 year between January 2012 and June 2017. Of the participants, 913 (1.2 percent) were diagnosed with T1DM, of whom 462 had available data for their first T1DM diagnosis.

FT1DM was detected in fifteen patients, corresponding to a prevalence rate of 3.2 percent relative to all T1DM patients. Compared to those without FT1DM, patients with the condition were older (p=0.0018), had lower HbA1c levels (p<0.0001), and lower fasting/peak C-peptide concentrations (p<0.0001) at the time of diagnosis.

In contrast, there were no between-group differences in terms of fasting plasma glucose, family history of diabetes, or pH level at diabetic ketoacidosis.

Notably, at the time of diagnosis, 100 percent of FT1DM patients also had diabetic ketoacidosis; the corresponding percentage in the non-FT1DM group was 19.7 percent (p<0.0001).

Analysis of the latest available data confirmed that HbA1c levels were significantly lower in FT1DM patients (7.0 percent vs 8.4 percent; p=0.0366), while total insulin dose, number of injections, and albumin-to-creatinine ratio tended to be lower without achieving significance.

“To our knowledge, this is the first multicentre study that included a large number of patients to show the detailed clinical characteristics and prevalence of FT1DM,” the researchers said. “This disease requires special attention from healthcare practitioners, as it is more vulnerable to the occurrence of acute and chronic complications, such as diabetic ketoacidosis, hypoglycaemia, diabetic microangiopathy, and mortality, than other types of diabetes.”