Rapid-Onset Type 1 Diabetes Mellitus without Pancreatic Exocrine Dysfunction

Masatoshi Yamazaki; Tatsuhiko Hayashi

doi:10.7326/0003-4819-137-2-200207160-00024

Letters |16 July 2002

Rapid-Onset Type 1 Diabetes Mellitus without Pancreatic Exocrine Dysfunction

Masatoshi Yamazaki, MD, PhD; Tatsuhiko Hayashi, MD, PhD

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TO THE EDITOR:

Imagawa and coworkers (1, 2) proposed a nonautoimmune fulminant subtype of type 1 diabetes mellitus characterized by the absence of insulitis and diabetes-related antibodies, rapid-onset elevated levels of serum pancreatic enzyme at diagnosis, and lymphocytic infiltration of the exocrine pancreas. However, pancreatic exocrine dysfunction may suggest an autoimmune rather than a nonautoimmune response in this subtype (3, 4).

We examined the pancreatic biopsy specimen of a 50-year-old Japanese man with rapid-onset type 1 diabetes mellitus. He was admitted to our hospital with diabetic ketoacidosis 3 days after rapid-onset symptoms of hyperglycemia. His blood glucose concentration was 26.3 mmol/L (474 mg/dL), and his glycosylated hemoglobin level was 0.061 (6.1%). Six days before admission, these values had been 3.9 mmol/L (70 mg/dL) and 0.054 (5.4%), respectively. Serum pancreatic enzyme levels were normal, and there were no diabetes-related antibodies. The patient's HLA-DRB1, DQA1, and DQB1 genotypes were *0405/*0410, *0303/*0303, and *0401/*0402. No significantly elevated titers of antiviral antibodies, including rotavirus, were detected.

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2002 American College of Physicians

Letters |16 July 2002

Rapid-Onset Type 1 Diabetes Mellitus without Pancreatic Exocrine Dysfunction

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Letters |16 July 2002

Rapid-Onset Type 1 Diabetes Mellitus without Pancreatic Exocrine Dysfunction

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