Background Fulminant type 1 diabetes (F1D) is a complex disease.Microarray analysis was used to identify gene expression changes and obtain understanding of the underlying mechanisms.Methods Microarray analysis was performed on peripheral blood mononuclear cells from six F1D patients and six matched healthy subjects.Real-time polymerase chain reaction was used to verify the differentially expressed genes.NK cell activity was detected by methyl thiazoleterazolium assay.Results Microarray analysis identified 759 genes differing in expression between F1D patients and controls at a false discovery rate of 0.05.Expression of TLR9,ELF4 and IL1RAP were verified and consistent with changes in microarray results.NK cell activity was decreased in F1D.With use of a knowledge base,differentially expressed genes could be placed within different pathways with predicted functions including interleukin-1,and tumor necrosis factor-α signaling.Conclusions These results identify several genes indicating possible mechanisms in F1D.NK cell dysfunction resulting from changes in expression of TLR9,ELF4 and IL1RAP,and pathways of interleukin-1 and tumor necrosis factor-α signaling might be involved in F1D through inducing β-cell dysfunction.