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Abstract：
BACKGROUND: Fulminant type 1 diabetes mellitus (FT1DM) that occurs during pregnancy or the perinatal period is known as pregnancy-related FT1DM (PF), always without history of abnormal glucose metabolism. Here, we present four patients who developed FT1DM during treatment but were first diagnosed with gestational diabetes mellitus (GDM).
METHODS: The clinical data of four patients with GDM combined with FT1DM admitted to our hospital between July 2018 and April 2021 were collected, and the patients and their infants were followed up. All patients were diagnosed with GDM during the second trimester and were treated. The blood glucose level elevated suddenly during the third trimester and then were diagnosed with FT1DM. Two patients had an insulin allergy, and two had symptoms of upper respiratory tract infection before onset. One patient developed ketoacidosis, and three developed ketosis. Two patients had cesarean section deliveries, and two had vaginal deliveries. The growth and development of the infants were normal. C-peptide levels were lower than those at onset, suggesting progressive impairment of islet function. The frequencies of the DRB1 09:01, DQB1 03: 03, DQA1 03:02, DPA1 01:03, DPA1 02:02, DPB1 05:01, DRB4 01:03, G 01:01, and G 01:04 human leukocyte antigen (HLA)-G alleles were high in the present study.
CONCLUSIONS: In comparison with pregnancy-associated FT1DM (PF), patients with GDM combined with FT1DM had an older age of onset, higher body mass index, slower onset, fewer prodromal symptoms, and less acidosis. The pathogenesis may be due to various factors affecting the already fragile β-cells of GDM patients with genetically susceptible class II HLA genotypes. We speculate that GDM combined with FT1DM during pregnancy, referred to as \"double diabetes,\" is a subtype of PF with its own unique characteristics that should be investigated further.
METHODS: The clinical data of four patients with GDM combined with FT1DM admitted to our hospital between July 2018 and April 2021 were collected, and the patients and their infants were followed up. All patients were diagnosed with GDM during the second trimester and were treated. The blood glucose level elevated suddenly during the third trimester and then were diagnosed with FT1DM. Two patients had an insulin allergy, and two had symptoms of upper respiratory tract infection before onset. One patient developed ketoacidosis, and three developed ketosis. Two patients had cesarean section deliveries, and two had vaginal deliveries. The growth and development of the infants were normal. C-peptide levels were lower than those at onset, suggesting progressive impairment of islet function. The frequencies of the DRB1 09:01, DQB1 03: 03, DQA1 03:02, DPA1 01:03, DPA1 02:02, DPB1 05:01, DRB4 01:03, G 01:01, and G 01:04 human leukocyte antigen (HLA)-G alleles were high in the present study.
CONCLUSIONS: In comparison with pregnancy-associated FT1DM (PF), patients with GDM combined with FT1DM had an older age of onset, higher body mass index, slower onset, fewer prodromal symptoms, and less acidosis. The pathogenesis may be due to various factors affecting the already fragile β-cells of GDM patients with genetically susceptible class II HLA genotypes. We speculate that GDM combined with FT1DM during pregnancy, referred to as \"double diabetes,\" is a subtype of PF with its own unique characteristics that should be investigated further.
摘要：
背景：妊娠期或围产期发生的暴发性1型糖尿病（FT1DM）被称为妊娠相关FT1DM（PF），始终没有糖代谢异常史。这里,我们介绍了4例患者在治疗期间发展为FT1DM,但首次诊断为妊娠期糖尿病(GDM).
方法：收集我院2018年7月至2021年4月收治的4例GDM合并FT1DM患者的临床资料。并对患者及其婴儿进行了随访。所有患者均在妊娠中期诊断为GDM，并接受治疗。在妊娠晚期血糖水平突然升高，然后被诊断为FT1DM。两个病人有胰岛素过敏,两个人在发病前有上呼吸道感染的症状。一名患者出现酮症酸中毒,和三个发展为酮症。两名患者剖宫产分娩,还有两个阴道分娩.婴儿生长发育正常。C肽水平低于发病时，提示胰岛功能进行性受损。DRB109：01，DQB103：03，DQA103：02，DPA101：03，DPA102：02，DPB105：01，DRB401：03，G01：01和G01：04人类白细胞抗原（HLA）-G等位基因的频率很高。
结论：与妊娠相关的FT1DM（PF）相比，GDM合并FT1DM患者发病年龄较大,较高的体重指数，起效较慢,前驱症状较少，酸中毒少了.发病机理可能是由于多种因素影响具有遗传易感II类HLA基因型的GDM患者已经脆弱的β细胞。我们推测妊娠期GDM合并FT1DM,被称为“双重糖尿病，“是PF的一种亚型，具有其独特的特征，应进一步研究。
方法：收集我院2018年7月至2021年4月收治的4例GDM合并FT1DM患者的临床资料。并对患者及其婴儿进行了随访。所有患者均在妊娠中期诊断为GDM，并接受治疗。在妊娠晚期血糖水平突然升高，然后被诊断为FT1DM。两个病人有胰岛素过敏,两个人在发病前有上呼吸道感染的症状。一名患者出现酮症酸中毒,和三个发展为酮症。两名患者剖宫产分娩,还有两个阴道分娩.婴儿生长发育正常。C肽水平低于发病时，提示胰岛功能进行性受损。DRB109：01，DQB103：03，DQA103：02，DPA101：03，DPA102：02，DPB105：01，DRB401：03，G01：01和G01：04人类白细胞抗原（HLA）-G等位基因的频率很高。
结论：与妊娠相关的FT1DM（PF）相比，GDM合并FT1DM患者发病年龄较大,较高的体重指数，起效较慢,前驱症状较少，酸中毒少了.发病机理可能是由于多种因素影响具有遗传易感II类HLA基因型的GDM患者已经脆弱的β细胞。我们推测妊娠期GDM合并FT1DM,被称为“双重糖尿病，“是PF的一种亚型，具有其独特的特征，应进一步研究。
