Differences between classic type 1 diabetes and fulminant type 1 diabetes in children and adolescents

Objective To understand whether fulminant type 1 diabetes mellitus(FT1DM) is different from classic type 1 diabetes mellitus(T1DM) in children and adolescents by summarizing the incidence and clinical characte-ristics of the 2 types of diabetes mellitus. Methods To study the characteristics of newly diagnosed T1DM patients hospitalized at Beijing Children's Hospital, Capital Medical University from January 2004 to December 2012, cases of FT1DM were screened as group A. And according to the rapid or slow onsets, patients were divided into 2 control groups: group B had classic T1DM onset with diabetes ketosis(DK) or diabetes ketoacidosis(DKA) within 10 days, and group C had classic T1DM within 30 days, while the differences were compared between FT1DM and classic T1DM. Results Eight hundred and fifty-three cases were diagnosed as T1DM in the past 9 years, including 11 cases in group A, 117 cases in group B and 565 cases in group C. FT1DM accounts for 1.29% of all newly diagnosed T1DM and 1.95% of classic T1DM within 30 days.In addition, onset age[1.33(0.95-9.25) years old vs 6.85(3.72-10.59) years old vs 7.00(4.00-10.08) years old, P=0.043], body mass index [16.89(15.63-19.74) kg/m2vs 14.49(13.46-16.19) kg/m2vs 14.79(13.60~16.38) kg/m2, P=0.004], incidence of flu-like symptoms(82% vs 47% vs 42%, P=0.000), abdominal symptoms before onset(55% vs 21% vs 16%, P=0.002), glycosylated hemoglobin(HbA1c)[(7.3±1.0)% vs (11.7±2.0)% vs (11.8±2.3)%, P=0.000], HCO3-[8.20(3.10-16.85) vs 15.05(10.13-21.10) vs 17.50(9.65-22.55), P=0.022], aspartate aminotransferase [30(26-33) U/L vs 21(15-27) U/L vs 22(18-29) U/L, P=0.010] of three groups had statistical differences, while the others had no statistical or clinical differences.Flu-like symptoms and abdominal symptoms before onset were common, and in the aspects of acute complications, insulin dosage and glucose control during follow-up, FT1DM showed no obvious differences from classic T1DM. Conclusions Incidence of FT1DM in children and adolescents was very low, and no apparent differences were found between FT1DM and classic T1DM. Key words: Fulminant type 1 diabetes mellitus; Classic type 1 diabetes mellitus; Clinical characteristic; Acute complication