Abstract
Background Fulminant type 1 diabetes mellitus (FT1DM) onsets abruptly and usually occurs within 1 week after the onset of hyperglycemic symptoms. Glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) are indicators that reflect short-term glucose levels. This study was aimed at investigating whether the 1,5-AG/GA index (AGI) is a suitable indicator for early FT1DM identification. Methods A total of 226 subjects were enrolled, all with glycated hemoglobin A1c (HbA1c) < 8.7%. FT1DM was diagnosed based on the 2012 Japan Diabetes Society criteria. Results The AGI level was 0.54 (0.17–1.36) in the whole group. It was lower in FT1DM patients (0.16 [0.10–0.25]). Among the participants whose HbA1c did not exceed 7.0%, the AGI of FT1DM decreased significantly compared to type 1A diabetes (T1ADM) and latent autoimmune diabetes in adults (LADA) patients (0.16 [0.12–0.26] vs. 0.46 [0.24–0.72] vs. 0.46 [0.24–0.72] P < 0.05). The receiver operating characteristic (ROC) curve showed that AGI can be used to distinguish FT1DM and T1ADM patients with HbA1c < 8.7%. Diagnosing FT1DM based on AGI ≤ 0.3 only can help narrow down suspected FT1DM by up to 26.87%. If we diagnosed FT1DM when AGI was ≤0.3 and HbA1c was ≤7.0%, the success rate further increased to 86.57%, among which 85.00% of FT1DM and 87.23% of T1ADM patients were successfully identified. Therefore, using the combination criteria of AGI and HbA1c would improve the differential diagnosis efficacy by 61.11% compared with the AGI criterion only. Conclusion AGI can help facilitate the early differential diagnosis of FT1DM and T1ADM when HbA1c < 8.7%, with an optimal cut-off point of 0.3.
Highlights
Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes mellitus that is mainly characterized by an abrupt onset of a severe metabolic disorder, markedly elevated blood glucose level, normal or slightly elevated glycated hemoglobin A1c (HbA1c), and almost complete or complete irreversible islet dysfunction [1, 2]
The analysis demonstrated that the optimal AG/GA index (AGI) cut-off point for identification was 0.29, with a specificity of 36.17% (95% confidence interval [CI]: 22.67–51.48%), a sensitivity of 95.00%, and an area under the curve (AUC) of 0.609
When we combined HbA1c with AGI and diagnosed FT1DM when AGI ≤ 0:3 and HbA1c ≤ 7:0%, the successful identification rate further increased to 86.57% (58/67), among which 85.00% (17/20) of FT1DM and 87.23% (41/47) T1ADM patients were successfully identified, with a positive predictive value (PPV) and negative predictive value (NPV) of 73.91% and 93.18%, respectively
Summary
Fulminant type 1 diabetes mellitus (FT1DM) is a new subtype of type 1 diabetes mellitus that is mainly characterized by an abrupt onset of a severe metabolic disorder, markedly elevated blood glucose level, normal or slightly elevated glycated hemoglobin A1c (HbA1c), and almost complete or complete irreversible islet dysfunction [1, 2]. HbA1c has certain limitations since it mainly reflects the average blood glucose level of the past 2 to 3 months, which far exceeds the duration of FT1DM [4]. Glycated albumin (GA), an indicator that reflects 2- to 3-week average glucose level, is recommended in stress hyperglycemia and has therapeutic effects evaluating after hypoglycated agent adjustment [8,9,10]. Among the participants whose HbA1c did not exceed 7.0%, the AGI of FT1DM decreased significantly compared to type 1A diabetes (T1ADM) and latent autoimmune diabetes in adults (LADA) patients (0.16 [0.12–0.26] vs 0.46 [0.24–0.72] vs 0.31 [0.19–0.43], both P < 0:05). If we diagnosed FT1DM when AGI was ≤0.3 and HbA1c was ≤7.0%, the success rate further increased to 86.57%, among which 85.00% of FT1DM and 87.23% of T1ADM patients were successfully identified. AGI can help facilitate the early differential diagnosis of FT1DM and T1ADM when HbA1c < 8:7%, with an optimal cut-off point of 0.3
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