Clinical characteristics of pregnancy related fulminant type 1 diabetes

Objective To investigate the clinical characteristics of pregnancy-associated fulminant type 1 diabetes mellitus (PF) and provide a reference for early clinical identification and intervention.Methods A retrospective collection was conducted on the clinical data of 5 PF patients who were treated in the First Affiliated Hospital of Guilin Medical University from January 2013 to April 2025. These data were compared with those of 14 female patients with newly diagnosed type 1 diabetes mellitus (T1DM) of childbearing age to analyze the clinical characteristics of PF and newly diagnosed T1DM patients. Results: The age of onset for PF patients ranged from 28 to 40 years, with a mean age of 32.80 ± 5.07 years. Onset occurred during pregnancy in three cases (at 24, 37, and 39 weeks of gestation, respectively) and postpartum in two cases (6 days and 13 days postpartum). Among the five PF patients, four presented with significant hyperglycemic symptoms (polydipsia, polyuria, dry mouth), three were accompanied by gastrointestinal symptoms, two had preceding upper respiratory tract infections, two exhibited fetal distress, and one experienced intrauterine fetal demise. Compared with T1DM, PF was characterized by a more rapid and significant decline in islet function and more accelerated disease progression. Conclusion: PF is characterized by an abrupt onset, marked hyperglycemia, relatively low HbA1c levels, and severe ketoacidosis, posing significant risks to both mother and infant. Early identification based on blood glucose, HbA1c, and pancreatic islet function indicators is crucial in clinical practice, along with the prompt initiation of insulin therapy and multidisciplinary collaboration to improve pregnancy outcomes.