{"title":"两例常规暴发性 1 型糖尿病:内源性胰岛素分泌耗竭过程及文献综述。","authors":"Takamasa Iwamoto, Shuji Hidaka, Kentaro Sada, Hirotaka Shibata","doi":"10.1007/s13340-024-00755-0","DOIUrl":null,"url":null,"abstract":"<p><p>Fulminant type 1 diabetes (FT1D) is a rapidly progressive form of diabetes in which the endogenous capacity to secrete insulin is depleted. The onset is unpredictable with conventional FT1D, and a few reports have tracked C-peptide in patients with conventional FT1D pre-onset. In this report, we present two typical cases of conventional FT1D where C-peptide was monitored from the onset of precursor symptoms to the development of diabetic ketoacidosis (DKA). Furthermore, we conducted a literature review and provide a detailed description of the process of C-peptide depletion in conventional FT1D. Case 1 involved a 72-year-old woman who initially presented with fever and fatigue. Case 2 involved a 45-year-old woman with fever, abdominal pain, and acute pancreatitis. In both cases, DKA developed five days after initial symptoms. A noteworthy observation in both cases was the drastic drop in C-peptide, which was detectable at initial presentation but depleted by the time of DKA diagnosis. These cases emphasize the importance of close follow-up of plasma glucose and serum C-peptide in cases presenting with infection and pancreatitis. Our literature review revealed that in conventional FT1D, endogenous insulin secretion becomes deficient in an average of 5.3 days. Regardless of any concomitant acute pancreatitis and/or pancreas enlargement, the period until endogenous insulin secretion became deficient showed no substantial variation. This result supports the concept that progression of conventional FT1D is more rapid than that of immune checkpoint inhibitor-related FT1D, which deplete insulin secretion in approximately 2 weeks.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13340-024-00755-0.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512938/pdf/","citationCount":"0","resultStr":"{\"title\":\"Two cases of conventional fulminant type 1 diabetes: following the depletion process of endogenous insulin secretion and literature review.\",\"authors\":\"Takamasa Iwamoto, Shuji Hidaka, Kentaro Sada, Hirotaka Shibata\",\"doi\":\"10.1007/s13340-024-00755-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Fulminant type 1 diabetes (FT1D) is a rapidly progressive form of diabetes in which the endogenous capacity to secrete insulin is depleted. 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引用次数: 0
摘要
暴发性 1 型糖尿病(FT1D)是一种内源性胰岛素分泌能力耗竭的快速进展型糖尿病。传统型 FT1D 的发病难以预测,有少数报道对传统型 FT1D 发病前患者的 C 肽进行了追踪。在本报告中,我们介绍了两例典型的常规 FT1D 病例,从前驱症状出现到发生糖尿病酮症酸中毒(DKA),我们都对 C 肽进行了监测。此外,我们还进行了文献综述,详细描述了传统 FT1D 中 C 肽消耗的过程。病例 1 涉及一名 72 岁的女性,最初表现为发热和乏力。病例 2 涉及一名发烧、腹痛和急性胰腺炎的 45 岁女性。在这两个病例中,DKA 都是在最初出现症状五天后发生的。这两个病例中值得注意的一点是 C 肽急剧下降,最初出现症状时还能检测到 C 肽,但在确诊 DKA 时 C 肽已消耗殆尽。这些病例强调了密切随访感染和胰腺炎病例血浆葡萄糖和血清 C 肽的重要性。我们的文献综述显示,在传统的 FT1D 中,内源性胰岛素分泌平均在 5.3 天内就会出现不足。无论是否伴有急性胰腺炎和/或胰腺肿大,内源性胰岛素分泌不足的时间均无显著差异。这一结果支持了一个概念,即传统的胰岛素抵抗进展比免疫检查点抑制剂相关的胰岛素抵抗进展更快,后者大约在两周内就会耗尽胰岛素分泌:在线版本包含补充材料,可在 10.1007/s13340-024-00755-0上查阅。
Two cases of conventional fulminant type 1 diabetes: following the depletion process of endogenous insulin secretion and literature review.
Fulminant type 1 diabetes (FT1D) is a rapidly progressive form of diabetes in which the endogenous capacity to secrete insulin is depleted. The onset is unpredictable with conventional FT1D, and a few reports have tracked C-peptide in patients with conventional FT1D pre-onset. In this report, we present two typical cases of conventional FT1D where C-peptide was monitored from the onset of precursor symptoms to the development of diabetic ketoacidosis (DKA). Furthermore, we conducted a literature review and provide a detailed description of the process of C-peptide depletion in conventional FT1D. Case 1 involved a 72-year-old woman who initially presented with fever and fatigue. Case 2 involved a 45-year-old woman with fever, abdominal pain, and acute pancreatitis. In both cases, DKA developed five days after initial symptoms. A noteworthy observation in both cases was the drastic drop in C-peptide, which was detectable at initial presentation but depleted by the time of DKA diagnosis. These cases emphasize the importance of close follow-up of plasma glucose and serum C-peptide in cases presenting with infection and pancreatitis. Our literature review revealed that in conventional FT1D, endogenous insulin secretion becomes deficient in an average of 5.3 days. Regardless of any concomitant acute pancreatitis and/or pancreas enlargement, the period until endogenous insulin secretion became deficient showed no substantial variation. This result supports the concept that progression of conventional FT1D is more rapid than that of immune checkpoint inhibitor-related FT1D, which deplete insulin secretion in approximately 2 weeks.
Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00755-0.
期刊介绍:
Diabetology International, the official journal of the Japan Diabetes Society, publishes original research articles about experimental research and clinical studies in diabetes and related areas. The journal also presents editorials, reviews, commentaries, reports of expert committees, and case reports on any aspect of diabetes. Diabetology International welcomes submissions from researchers, clinicians, and health professionals throughout the world who are interested in research, treatment, and care of patients with diabetes. All manuscripts are peer-reviewed to assure that high-quality information in the field of diabetes is made available to readers. Manuscripts are reviewed with due respect for the author''s confidentiality. At the same time, reviewers also have rights to confidentiality, which are respected by the editors. The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.