Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2024; 12(4): 787-794
Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.787
Gestational diabetes mellitus combined with fulminant type 1 diabetes mellitus, four cases of double diabetes: A case report
Hui Li, Yun Chai, Wei-Hong Guo, Yu-Meng Huang, Xiao-Na Zhang, Wen-Li Feng, Qing He, Jin Cui, Ming Liu
Hui Li, Yun Chai, Wei-Hong Guo, Yu-Meng Huang, Xiao-Na Zhang, Wen-Li Feng, Qing He, Jin Cui, Ming Liu, Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin 300052, China
Co-corresponding authors: Jin Cui and Ming Liu.
Author contributions: Li H analyzed data and wrote the paper; Chai Y collected data and performed research; Guo WH collected data; Huang YM collected data and revised the manuscript; Zhang XN collected data; Feng WL analyzed data and revised the manuscript; He Q performed research and supervision; Cui J designed the study and revised the paper; Liu M designed the study and analyzed data. All authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript. Cui J and Liu M contributed equally to this work as co-corresponding authors. The reasons for designating Cui J and Liu M as co-corresponding authors are twofold. First, all the work was done under the instructions of Cui J and Liu M. The designation of co-corresponding authors accurately reflects the equal contribution to this work, this collaboration helps share knowledge and resources, improve the quality and efficiency of our research. Second, the corresponding authors bear ultimate responsibility for the accuracy and integrity of the paper, co-corresponding authors can clarify everyone's contributions and responsibilities, avoid potential disputes or misunderstandings. In summary, we believe that designating Cui J and Liu M as co-corresponding authors is fitting for our manuscript, which can promote academic collaboration, clarify responsibilities and contributions, thereby improving research quality and academic influence.
Supported by National Natural Science Foundation of China, No. 82270864.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin Cui, PhD, Doctor, Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, China. cuijin2001@163.com
Received: September 16, 2023
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
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).

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Fulminant type 1 diabetes mellitus; Gestational diabetes mellitus; Pregnancy-related fulminant type 1 diabetes mellitus; Double diabetes; Case report

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.