Fulminant type 1 diabetes: The clinical and continuous glucose monitoring characteristics in Chinese patients

The purpose of the current study was to investigate the clinical characteristics of fulminant type 1 diabetes mellitus ( FT 1 DM ) in Chinese patients and to further determine their glycaemic profiles through continuous glucose monitoring ( CGM ). Thirty subjects who were diagnosed with FT 1 DM according to the 2012 JDS criteria were enrolled. Clinical characteristics were compared to those reported in Japanese FT 1 DM . All subjects received retrospective CGM for 3 days after being converted to subcutaneous insulin injection therapy. Chinese FT 1 DM patients presented with a shorter duration of symptoms (2.84 ± 2.42 days vs 4.4 ± 3.1 days, P  <   0.01), worse islet function (fasting C‐peptide, 0.09 ± 0.11 ng/ mL vs 0.30 ± 0.21 ng/ mL ; 2‐hour C‐peptide, 0.13 ± 0.14 ng/ mL vs 0.30 ± 0.30 ng/ mL , both P  <   0.01), lower prevalence of flu‐like symptoms (46.7% vs 71.4%, P  <   0.05), and a significantly higher GADA positive rate (23.3% vs 5.1%, P  <   0.01) when compared with Japanese patients. The CGM results showed that the mean time in range ( TIR ) of FT 1 DM patients was 49.8 ± 22.1%, while mean amplitude of glycaemic excursion ( MAGE ) and standard deviations of sensor glucose ( SDSG ) were 7.58 ± 3.59 mmol/L and 3.19 ± 1.22 mmol/L, respectively, with nearly 1/3 participants coefficient of variation ( CV ) > 36% (all are male), suggesting a large glucose fluctuation. The female patients were further divided into pregnancy‐related FT 1 DM ( PF ) and non‐ PF ( NPF ) subgroups (both n   =   5), and we found that PF patients had a significantly higher TIR than NPF patients (77.0 ± 16.1% vs 41.0 ± 22.4%, P  <   0.05). There were heterogeneities in the clinical characteristics of FT 1 DM patients, and the CGM results indicated a very low TIR and large glucose fluctuation which needs careful attention.