Abstract
Fulminant type 1 diabetes (FT1D) could present diabetes ketoacidosis (DKA) at early onset. It is crucial to identify FT1D from DKA manifestations in time at clinical practice. This study was aimed at investigating whether the fulminant index (FI), encompassing plasma glucose (PG) to glycated haemoglobin (HbA1c) ratio (PG/HbA1c), serum potassium ion (K+ ) to HbA1c ratio (K+ /HbA1c) and serum sodium ion (Na+ ) multiplied by HbA1c (Na+ *HbA1c), is a feasible indicator for early FT1D diagnosis. A total of 78 subjects were enroled, including 40 FT1D patients and 38 non-FT1D patients with DKA. We utilised receiver operating characteristic (ROC) curve analysis to determine the FI cut-off values between FT1D and non-FT1D groups and examined efficacies of FI based on statistics. ROC curve analyses showed that the maximum Youden's index for PG/HbA1c bonding to a cut-off value of 4.389, with the sensitivity of 75.0% and specificity of 81.6% in identifying FT1D from DKA. And optimal K+ /HbA1c cut-off value was 0.728 with a sensitivity of 90.0% and specificity of 84.2%. For Na+ *HbA1c, the best cut-off value was 923.65, and its sensitivity and specificity were 85% and 73.7%, respectively. These results suggested FI could work as a valid and convenient indicator for differentiating FT1D from initial DKA patients. FI (K+ /HbA1c) presented the best efficacy as an independent index.
Highlights
Fulminant type l diabetes mellitus (FT1D) is a subtype of type 1 diabetes mellitus characterized by aggressive disease progression
We proposed a set of quantitative diagnostic tool named fulminant index (FI), which was calculated based on plasma glucose (PG), serum potassiumion (K+) level, serum sodiumion (Na+) level, and glycated hemoglobin (HbA1c) level
All included Fulminant type 1 diabetes (FT1D) cases meet the diagnostic criteria composed by the Committee of the Japan Diabetes Society in 2012: diabetic ketosis or ketoacidosis occurs soon after the onset of hyperglycaemic symptoms and the patient presents with PG level ≥ 16.0 mmol/L and HbA1c level < 8.7% at the first visit and urinary C-peptide excretion < 10 ug/day, or fasting serum C-peptide level < 0.10 nmol/L and postprandial serum C-peptide < 0.17 nmol/L at onset[6]
Summary
Fulminant type l diabetes mellitus (FT1D) is a subtype of type 1 diabetes mellitus characterized by aggressive disease progression. As observed in the previous study[5] and our clinical work, fulminant type l diabetes mellitus (FT1D) patients usually present rushed clinical course and may generate ketosis or DKA at their early disease onset. Identification of FT1D cases can help timely treatment and prevent death cases. To our current knowledge, it remains a significant problem differentiating FT1D patients from general DKA patients in the emergency room. We aimed to seek a better diagnostic pipeline for FT1D independent of C-peptide assessment, to achieve prompt differentiation and early management of potential FT1D patients showed up in the emergency room. We calculated the estimated FI cutting-off points and verified its efficiency in differentiating FT1D from non-FT1D DKA patients through receiver operating characteristic (ROC) curve analysis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
