{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:53Z","timestamp":1784557073867,"version":"3.55.0"},"reference-count":10,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T00:00:00Z","timestamp":1656633600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,7,1]]},"abstract":"\n Summary<\/jats:title>\n Fulminant type 1 diabetes mellitus (FT1DM) is characterised by extremely rapid destruction of pancreatic beta cells. An association between FT1DM and pregnancy has been reported and can lead to unfavourable pregnancy outcomes without timely treatment. We report a case of FT1DM in a pregnancy with gestational diabetes mellitus (GDM), the first of its kind in the English literature to date. A 27-year-old woman with insulin-requiring GDM presented with rapidly deteriorating glycaemic control in her third trimester of pregnancy despite good concordance to treatment. The investigation identified the hallmarks of FT1DM: hyperglycaemia with acute metabolic decompensation and non-immune-mediated beta-cell failure. She received prompt treatment with intravenous insulin therapy and was transitioned to subcutaneous insulin once biochemical improvement had been achieved, albeit with higher insulin requirements than before. She had a good pregnancy outcome and delivered a healthy male infant 5 weeks later through induction of labour. Due to persistent beta-cell dysfunction, she remained on basal-bolus insulin postpartum. This case highlights the importance of early recognition and treatment of FT1DM in pregnancy to prevent adverse maternal and fetal prognoses.<\/jats:p>\n <\/jats:sec>\n \n Learning points<\/jats:title>\n \n \n Fulminant type 1 diabetes mellitus (FT1DM) is a subtype of type 1 diabetes characterised by extremely rapid beta-cell destruction, leading to abrupt-onset hyperglycaemia with ketosis or ketoacidosis.<\/jats:p>\n <\/jats:list-item>\n \n The pathognomonic characteristics of FT1DM include the development of diabetic ketosis or ketoacidosis typically within 7 days after the onset of symptoms of hyperglycaemia, a near-normal level of glycated haemoglobin despite elevated plasma glucose levels and the absence of islet cell autoantibodies.<\/jats:p>\n <\/jats:list-item>\n \n The pathophysiology of FT1DM is unclear but the association with genetic predisposition, viral infection and pregnancy has been reported.<\/jats:p>\n <\/jats:list-item>\n \n Due to its predilection for pregnancy, clinicians should have a high index of suspicion for FT1DM in pregnant women with rapidly progressing hyperglycaemic ketoacidosis.<\/jats:p>\n <\/jats:list-item>\n \n As diabetic ketoacidosis in pregnancy is associated with adverse maternal and fetal outcomes, immediate initiation of treatment in pregnant women with suspected FT1DM is extremely vital to prevent morbidity and mortality, even if investigations are still underway.<\/jats:p>\n <\/jats:list-item>\n \n Patients with FT1DM require lifelong insulin therapy due to the complete loss of beta-cell function.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:sec>","DOI":"10.1530\/edm-22-0262","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T05:15:10Z","timestamp":1658985310000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":4,"title":["Fulminant type 1 diabetes mellitus in a GDM pregnancy: early recognition is vital for maternal and fetal outcomes"],"prefix":"10.1530","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1207-6523","authenticated-orcid":true,"given":"Kay Hau Aaron","family":"Choy","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Diabetes, Barwon Health, Geelong, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tang","family":"Wong","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia"},{"name":"Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia"},{"name":"School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rena H M","family":"Cao","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia"},{"name":"Department of Respiratory Medicine, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff R","family":"Flack","sequence":"additional","affiliation":[{"name":"Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia"},{"name":"Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia"},{"name":"School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Journal of Medical Case Reports","article-title":"Fulminant type 1 diabetes mellitus associated with coxsackievirus type B1 infection during pregnancy: a case report","volume":"13","author":"Hayakawa","year":"2019","unstructured":"Hayakawa TNakano YHayakawa KYoshimatu HHori YYamanishi KYamanishi HOta TFujimoto T. Fulminant type 1 diabetes mellitus associated with coxsackievirus type B1 infection during pregnancy: a case report. Journal of Medical Case Reports201913 186. (https:\/\/doi.org\/10.1186\/s13256-019-2130-8)31215492"},{"key":"bib2","series-title":"Diabetes Care","doi-asserted-by":"publisher","first-page":"2345","DOI":"10.2337\/diacare.26.8.2345","article-title":"Fulminant type 1 diabetes: a nationwide survey in Japan","volume":"26","author":"Imagawa","year":"2003","unstructured":"Imagawa AHanafusa TUchigata YKanatsuka AKawasaki EKobayashi TShimada AShimizu IToyoda TMaruyama T, Fulminant type 1 diabetes: a nationwide survey in Japan. Diabetes Care2003262345\u20132352. (https:\/\/doi.org\/10.2337\/diacare.26.8.2345)10.2337\/diacare.26.8.234532696818"},{"key":"bib3","series-title":"Journal of Clinical Endocrinology and Metabolism","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1210\/jc.2005-1943","article-title":"Clinical and immunogenetic characteristics of fulminant type 1 diabetes associated with pregnancy","volume":"91","author":"Shimizu","year":"2006","unstructured":"Shimizu IMakino HImagawa AIwahashi HUchigata YKanatsuka AKawasaki EKobayashi TShimada AMaruyama T, Clinical and immunogenetic characteristics of fulminant type 1 diabetes associated with pregnancy. Journal of Clinical Endocrinology and Metabolism200691471\u2013476. (https:\/\/doi.org\/10.1210\/jc.2005-1943)10.1210\/jc.2005-194317179928"},{"key":"bib4","series-title":"Internal Medicine Journal","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1111\/imj.13218","article-title":"Fulminant type 1 diabetes in pregnancy","volume":"46","author":"Farrant","year":"2016","unstructured":"Farrant MTRowan JACundy T. Fulminant type 1 diabetes in pregnancy. Internal Medicine Journal2016461212\u20131215. (https:\/\/doi.org\/10.1111\/imj.13218)10.1111\/imj.1321831215492"},{"key":"bib5","series-title":"Brazilian Journal of Medical and Biological Research","article-title":"Fulminant type 1 diabetes mellitus in pregnancy","volume":"53","author":"Li","year":"2020","unstructured":"Li CYLi YYou ZYLiu YRWang YJMu TZhao CZYi ZMZhang YW. Fulminant type 1 diabetes mellitus in pregnancy. Brazilian Journal of Medical and Biological Research202053 e9633. (https:\/\/doi.org\/10.1590\/1414-431x20209633)32696818"},{"key":"bib6","series-title":"Nature Clinical Practice: Endocrinology and Metabolism","first-page":"36","article-title":"Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitioners","volume":"3","author":"Hanafusa","year":"2007","unstructured":"Hanafusa TImagawa A. Fulminant type 1 diabetes: a novel clinical entity requiring special attention by all medical practitioners. Nature Clinical Practice: Endocrinology and Metabolism2007336\u201345; quiz 2p following 69. (https:\/\/doi.org\/10.1038\/ncpendmet0351)17179928"},{"key":"bib7","series-title":"Journal of Diabetes Investigation","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1111\/jdi.12024","article-title":"Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012)","volume":"3","author":"Imagawa","year":"2012","unstructured":"Imagawa AHanafusa TAwata TIkegami HUchigata YOsawa HKawasaki EKawabata YKobayashi TShimada A, Report of the Committee of the Japan Diabetes Society on the Research of Fulminant and Acute-onset type 1 diabetes mellitus: new diagnostic criteria of fulminant type 1 diabetes mellitus (2012). Journal of Diabetes Investigation20123536\u2013539. (https:\/\/doi.org\/10.1111\/jdi.12024).10.1111\/jdi.12024"},{"key":"bib8","series-title":"Gut","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis\u20132012: revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"Banks","year":"2013","unstructured":"Banks PABollen TLDervenis CGooszen HGJohnson CDSarr MGTsiotos GGVege SS & Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis\u20132012: revision of the Atlanta classification and definitions by international consensus. Gut201362102\u2013111. (https:\/\/doi.org\/10.1136\/gutjnl-2012-302779)10.1136\/gutjnl-2012-302779"},{"key":"bib9","series-title":"Postgraduate Medical Journal","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1136\/pmj.79.934.454","article-title":"Diabetic ketoacidosis in pregnancy","volume":"79","author":"Kamalakannan","year":"2003","unstructured":"Kamalakannan DBaskar VBarton DMAbdu TA. Diabetic ketoacidosis in pregnancy. Postgraduate Medical Journal200379454\u2013457. (https:\/\/doi.org\/10.1136\/pmj.79.934.454)10.1136\/pmj.79.934.454"},{"key":"bib10","series-title":"Australian and New Zealand Journal of Obstetrics and Gynaecology","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1111\/j.1479-828X.1999.tb03122.x","article-title":"Symptoms during normal pregnancy: a prospective controlled study","volume":"39","author":"Zib","year":"1999","unstructured":"Zib MLim LWalters WA. Symptoms during normal pregnancy: a prospective controlled study. Australian and New Zealand Journal of Obstetrics and Gynaecology199939401\u2013410. (https:\/\/doi.org\/10.1111\/j.1479-828x.1999.tb03122.x)10.1111\/j.1479-828X.1999.tb03122.x"}],"container-title":["Endocrinology, Diabetes & Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2022\/1\/EDM22-0262.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0262.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2022\/1\/EDM22-0262.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:47:56Z","timestamp":1784555276000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/3389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,1]]},"references-count":10,"URL":"https:\/\/doi.org\/10.1530\/edm-22-0262","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,1]]}}}