Pregnancy-associated fulminant type 1 diabetes mellitus: Two case reports and literature review

Pregnancy-associated fulminant type 1 diabetes mellitus (PFT1DM) occurs during pregnancy or within 2 weeks after delivery. Despite the low incidence of PFT1DM in obstetrics, it poses a great threat to the lives of mothers and infants. The present study reported the management of 2 cases with PFT1DM, emphasizing the importance of early diagnosis and appropriate treatments to improve pregnancy outcomes. Case 1 was a 35-year-old woman at 17 weeks of gestation, who was admitted due to polyuria and polydipsia, fatigue, chest tightness and hyperglycemia. Case 2 was a 28-year-old woman who had been diagnosed with gestational diabetes mellitus at 24 weeks of gestation, who was admitted at 26 weeks of gestation due to hyperglycemia and ketonuria. In both cases, elevated fasting blood glucose, near-normal glycosylated hemoglobin (HbA1c) levels and low serum fasting C-peptide indicated severe pancreatic beta-cell dysfunction. Serum glutamic acid decarboxylase antibody (GAD-Ab) testing was negative, confirming the diagnosis of PFT1DM in both patients. These patients were immediately treated with intravenous insulin and rehydration therapy to correct diabetic ketoacidosis, and were subsequently switched to daily subcutaneous insulin injections. After discharge, the insulin dose was adjusted weekly through outpatient follow-up. In both cases, a healthy male baby was delivered by a caesarean section at 37-38 weeks of gestation, with a body weight of 3,350 and 3,410 grams, respectively. In conclusion, this study presented two cases of PFT1DM with favorable fetal outcomes. Clinically, obstetricians should be highly vigilant of PFT1DM in pregnant women presenting with diabetic ketoacidosis symptoms. Prior to initiating treatments, systematic monitoring of blood glucose, HbA1c and C-peptide is essential to prevent the use of fluids or medications that may lead to a rise in blood glucose. Testing for GAD-Ab helps confirm the diagnosis of PFT1DM. Enhancing awareness and education about PFT1DM is essential, along with emphasizing the critical need for timely medical attention to prevent adverse prognosis in mothers and infants.