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Clinical study of pregnancy-associated fulminant type 1 diabetes

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Abstract

Background

Studies reported that fulminant type 1 diabetes (fT1DM) can occurred during pregnancy or within 2 weeks after delivery, and was defined as pregnancy-associated fulminant type 1 diabetes (PF). In PF patients, plasma glucose (PG) levels have an abrupt rise while glycated hemoglobin (HbA1C) levels are not markedly elevated, resulting in a sharply increased PG/HbA1C ratio.

Methods

We studied 30 PF patients, 21 non-pregnant fulminant type 1 diabetes (NPF) patients, and 26 female patients of child-bearing age (13–49 years) with diabetic ketoacidosis (DKA), all from China. We analyzed the PG/HbA1C ratio among these groups, with the goal of finding a method for predicting PF. The clinical and biochemical characteristics of the PF and NPF patients were analyzed and compared with the characteristics of the DKA patients. In order to detect PF in DKA patients, receiver-operating characteristic curves analysis was used to identify the cut-off points of the PG/HbA1C ratio.

Results

When we compared the clinical characteristics of these three groups, we found that the onset of hyperglycemic symptoms, arterial PH value, serum potassium, PG, HbA1C, fasting and postprandial serum C-peptide concentration, glutamic acid decarboxylase (GAD) antibodies positivity were all significantly different (P < 0.001). The PG/HbA1C ratio was significantly higher in PF and NPF patients (5.29 ± 1.39 and 6.38 ± 2.62) than in DKA patients (1.93 ± 0.55; P < 0.001). Receiver-operating characteristic (ROC) curves analyses showed that PG/HbA1C ratio at a cut-off value of 3.3 resulted in the highest Youden index, with corresponding sensitivity of 93 and 100% specificity for identifying PF from DKA.

Conclusions

PF patients showed a more severe acidosis, with maternal and fetal mortality rates being high. PG/HbA1C ratio with a threshold of ≥3.3 can be used as a cut-off point in predicting PF from DKA in China. Elevated PG/HbA1C ratio at the time of diagnosis is predictive for more severe insulin secretion dysfunction and poor prognosis.

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Acknowledgements

This study was funded by Shenzhen Health and Family Planning Research Project (grant number 201401078). Participating hospitals of Type 1 Diabetes Federation of Shenzhen were the Eighth Affiliated Hospital of Sun Yat-sen University, Qingyuan People’s Hospital, Third People’s Hospital of Dongguan, The Third Affiliated Hospital of Southern Medical University, Luohu People’s Hospital, and the Second People’s Hospital of Shenzhen. The author thanks Dr. Wenjuan Jia from Qingyuan People’s Hospital, Dr. Ruike Liu from the Third People’s Hospital of Dongguan, Dr. Jie Shen from the Third Affiliated Hospital of Southern Medical University, Dr. Ping Tang from Luohu People’s Hospital of Shenzhen, and Dr. Shujuan Chen from the Second People’s Hospital of Shenzhen for their suggestions and data provided.

Funding

L.L. has received research grants from Shenzhen Health and Family Planning Research Project (grant #201401078).

Author contributions

L.L., W.J., and J.S. designed the project; L.L., W.J., and R.L. collected and analyzed clinical data; L.L. and R.L. did the statistical analysis; L.L. and J.S. wrote the manuscript; all authors contributed to manuscript finalization.

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Authors and Affiliations

  1. Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Zhongshan Road West 183, 510630, Guangzhou, Guangdong Province, China

    Lan Liu, Wenjuan Jia, Ruike Liu & Jie Shen

  2. Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shennan Middle Road 3025#, 518033, Shenzhen, Guangdong Province, China

    Lan Liu

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  1. Lan Liu
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  2. Wenjuan Jia
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Correspondence to Jie Shen.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Liu, L., Jia, W., Liu, R. et al. Clinical study of pregnancy-associated fulminant type 1 diabetes. Endocrine 60, 301–307 (2018). https://doi.org/10.1007/s12020-018-1556-x

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  • DOI: https://doi.org/10.1007/s12020-018-1556-x

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