Fulminant and Slowly Progressive Type 1 Diabetes Associated with Pregnancy

Abstract

Type 1 diabetes is classified into three clinical subtypes: fulminant type 1 diabetes, acute-onset type 1 diabetes, and slowly progressive type 1 diabetes, also known as latent autoimmune diabetes in adults. Among these, the fulminant and slowly progressive forms may develop in association with pregnancy and are herein collectively referred to as "pregnancy-associated type 1 diabetes". Fulminant type 1 diabetes can manifest suddenly during pregnancy, often accompanied by ketoacidosis, posing a significant risk to both the mother and the fetus. Early diagnosis and treatment are, therefore, critical. In pregnant women with no prior history of diabetes who present with marked hyperglycemia (≥288 mg/dL) but relatively low HbA1c levels (<8.7%), fulminant type 1 diabetes should be suspected, and insulin therapy should be initiated immediately. Conversely, women diagnosed with gestational diabetes who test positive for anti-islet autoantibodies are at high risk of developing slowly progressive type 1 diabetes postpartum. For these patients, regular monitoring of blood glucose levels, HbA1c, and endogenous insulin secretion is essential for early detection and management.

Keywords: anti-islet autoantibodies; fulminant type 1 diabetes; gestational diabetes; latent autoimmune diabetes in adults; prediction; pregnancy; slowly progressive type 1 diabetes.

Figure 1

Th17/Treg balance in the establishment and maintenance of pregnancy The figure was adapted from Ref. [27].

Figure 2

Subtypes of pregnancy-associated type 1 diabetes.

Figure 3

Association between fulminant type 1 diabetes and pregnancy The figure was adapted from Ref. [34].

Figure 4

The possible pathogenesis of pregnancy-associated fulminant type 1 diabetes. IFN, interferon; CXCL10, C-X-C motif chemokine ligand 10; CXCR3, C-X-C motif chemokine receptor 3.

Figure 5

Prediction of type 1 diabetes in gestational diabetes.