Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.787
Peer-review started: September 16, 2023
First decision: November 30, 2023
Revised: December 13, 2023
Accepted: February 10, 2024
Article in press: January 10, 2024
Published online: February 6, 2024
Processing time: 130 Days and 16.7 Hours
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).
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.
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.
Core Tip: We believe that 4 aspects of this manuscript will make it intresting. First, we reported 4 similar cases first diagnosed with gestational diabetes mellitus (GDM) but then developed fulminant type 1 diabetes mellitus (FT1DM) during treatment. Second, we summarized the clinical manifestations of the patients with related literature, in comparison with classical pregnancy-related FT1DM (PF). Third, we tested the class II human leukocyte antigen genotype in patients of GDM combined with FT1DM, and discovered the higher frequencies of haplotypes. Finally, we propose that GDM combined with FT1DM as a subtype of PF should be classified as double diabetes occurring during pregnancy.