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A Filipino Patient With Fulminant Type 1 Diabetes

  1. Matsuo Taniyama, MD1,
  2. Ryo Katsumata, MD23,
  3. Kanemi Aoki, MD1 and
  4. Seiji Suzuki, MD1
  1. 1Department of Internal Medicine, Division of Endocrinology and Metabolism, Showa University Fujigaoka Hospital, Kanagawa, Japan
  2. 2Department of Internal Medicine, Shiroyama Hospital, Gunma, Japan
  3. 3Third Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan
  1. Address correspondence to Matsuo Taniyama, MD, Division of Endocrinology and Metabolism, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba, Yokohama, Kanagawa 227-8501 Japan. E-mail: taniyama{at}showa-university-fujigaoka.gr.jp

Fulminant type 1 diabetes is characterized by abrupt onset of loss of pancreas β-cell function with low initial HbA1c levels and absence of autoantibodies to islet antigens (1). Initial histological examinations revealed the absence of insulitis, and it was thought that the autoimmune process did not mediate this type of diabetes. However, with an accumulation of cases, possible involvement of an immune response to islet antigens has come to light. CD8+ lymphocytes infiltrating the pancreatic islets were seen in a patient who died of fulminant type 1 diabetes (2), and peripheral GAD-reactive interferon-γ-producing CD4+ lymphocytes were detected in another case of fulminant type 1 diabetes (3). Thus, T-cell-mediated autoimmunity may be involved. HLA analyses also indicate that an autoimmune process similar to that in autoimmune type …

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