Rapid Onset may be a nonautoimmune form

Japanese authors suggest a viral cause

Adults who develop acute symptoms of Type 1 diabetes in a matter of days rather than months or years may be displaying what Japanese scientists are calling a subset of the disease.

Rapid Onset (RO) diabetes has not been seen widely in the United States, but the American medical community has been aware of the rare form of the disease for many years.

"This a nonautoimmune form of the disease which develops very abruptly. No diabetes antibodies are present and it may therefore be caused by an entirely different mechanism," said the Joslin Diabetes Center in Boston in a statement after the Japanese research was published in the Feb. 3 issue of the New England Journal of Medicine.

RO diabetes was characterized by HbA1c levels of 8.5% or lower, signifying the "remarkably abrupt onset" of the disease, the paper said. Excessive alcohol consumption as a trigger for the disease was ruled out since none of the subjects with RO diabetes were heavy drinkers.

Researchers at the University of Osaka in Japan wrote in their conclusion: "A viral cause is suggested by the rapid onset of diabetes, the presence of lymphatic filtrates in the exocrine pancreas and the affinity of several viruses for exocrine pancreatic tissue."

"If it is viral, it is a needle in a haystack in the gamut of known viruses," says Mark Anderson, MD, PhD, a Joslin fellow in immunology.

A colleague at Joslin, Diane Mathis, PhD, co-director of the section on immunology, suggests the study’s findings may not point toward a viral cause. "This form of diabetes may be autoimmune in nature, but the target is the massive endocrine pancreas around the islets and the beta cells die as an indirect effect of the surrounding inflammation."

Whatever the cause of RO diabetes, the treatment would be identical to the treatment that would be given any patient with diabetes.

"Just recognize there may be a pool of patients with a more rapid progression of symptoms. They may present with ketoacidosis with no prior history," says Anderson. "But every emergency room knows how to treat them."

Rapid progression means as little as four days from the development of the first symptoms, meaning the beta cells were destroyed suddenly, leaving no insulin reserves, says Richard Furlanetto, MD, PhD, scientific director of the Juvenile Diabetes Foundation in New York.

The normal progression of Type 1 diabetes usually begins to manifest in bed wetting, extreme thirst and hunger that can take place over the course of months or even years, says Furlanetto.

He noted that Japanese physicians gained this information about the beta cell function and the inflammation of the pancreas because they are permitted to biopsy the pancreases of patients, something that is not done in the United States.

Strangely, if RO patients become diabetic without an autoimmune response, they may be excellent candidates for transplants, concludes Anderson.

[Contact Mark Anderson at (617) 732-2400 and Richard Furlanetto at (800) 533-2873.]