Neutropenia in 6 cases of childhood onset type 1 diabetes and its possible mechanisms

OBJECTIVE: Type 1 diabetes (T1D) is a chronic inflammatory disease caused by a selective destruction of the pancreatic β-cells. There are few reports on peripheral neutropenia in T1D for different reasons. We reported 6 cases of childhood onset T1D combined with neutropenia and explored its possible mechanisms. METHODS: The clinical diagnosis and treatment course of 6 cases of childhood onset T1D combined with neutropenia, who were hospitalized in our hospital from January 2013 to December 2016, were studied retrospectively. RESULTS: We have diagnosed and treated 38 cases of childhood onset T1D during this period, while only 6 cases (15.79%) had neutropenia. The diagnostic ages of the 6 cases ranged from 5 to 12 years. Diabetic ketoacidosis (DKA) was complicated in 5 cases. Neutropenia happened within 14 to 21 days of the onset of disease and 3 to 11 days after using insulin, respectively, and returned spontaneously to normal range within 5 to 9 days. The serum levels of granulocyte colony-stimulating factor (G-CSF) and granulocyte macrophage colony-stimulating factor (GM-CSF) increased slightly before the usage of insulin in all 6 cases, and decreased to normal range after the usage of insulin. CONCLUSION: Neutropenia can be seen in childhood onset T1D, and can return spontaneously to normal range without special treatments. The possible mechanisms might be the regulation effects of insulin on G-CSF and GM-CSF.