Acute pancreatitis may be a pathogenic factor of fulminant type 1 diabetes mellitus

Abstract

[...]insulin treatment was started. According to the diagnostic criteria of FT1DM, case 1 could be definitely diagnosed. The etiology and pathogenesis of FT1DM are not well understood, but may be related to genetic susceptibility, viral infection, autoimmunity, and pregnancy. Besides our two cases of FT1DM after AP, there were several similar cases reported in Japan. [...]we suspect that AP is a pathogenic factor of FT1DM. Hirota et al[2] have reported that four of nine cases with FT1DM were diagnosed with AP and hyperinsulinemic hypoglycemia appeared 1 to 3 days after initial symptoms. [...]AP caused rapid destruction of islets, leading to hyperinsulinemia-related hypoglycemia, followed by hyperglycemia. IFN-γ can both damage β-cells and accelerate the production of CXCL10 from the remaining β-cells, further activating cell-mediated autoimmune response until β-cells are completely destroyed. [...]the destruction of β-cells in FT1DM is the result of a vicious cycle. [...]we speculate that on the basis of genetic predisposition, the immune response during AP results in immune damage and severe destruction of β-cells. [...]AP may be a pathogenic factor of FT1DM.