Children with type 1 diabetes who experienced a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis

Abstract

ImportanceLandmark studies showed that partial clinical remission in new-onset type 1 diabetes is associated with reduced prevalence of long-term complications, but early clinical indicators of this favorable outcome are poorly characterized.AimTo determine if there were any differences in lipid parameters, especially LDL-cholesterol, between remitters and non-remitters 4 to 5 years after the diagnosis of type 1 diabetes after controlling for hemoglobin A1c, body mass index, and pubertal status.Subjects and methodsA longitudinal retrospective cohort study of 123 subjects of mean age 11.9 ± 2.9 years, [male 11.7 ± 2.9 years, (n = 55); female 12.0 ± 2.9 years, (n = 68), p = 0.60] with type 1 diabetes of 4–5 years duration. Anthropometric and biochemical data were collected at the 4th or 5th year after diagnosis in line with the American Diabetes Association recommendation to initiate screening for complications in children either at the beginning of puberty or 4–5 years after diagnosis. Puberty was defined by Tanner stages II-V. Partial clinical remission was defined by the gold-standard insulin-dose adjusted hemoglobin A1c (IDAA1c) of ≤9.ResultsThere were 44 (35.8%) remitters (age 13.0 ± 2.5y; male 52.3%). Both the total cholesterol and LDL-cholesterol were significantly lower in remitters compared to non-remitters: LDL-C: 78.8 ± 28.7 mg/dL vs. 91.6 ± 26.5 mg/dL, p = 0.023; and total cholesterol: 151.5 ± 32.6 mg/dL vs. 167.0 ± 29.6 mg/dL, p = 0.015. Other lipid fractions were similar between the groups. There were no differences between the groups for glycemic control, body mass index z score, thyroid function, celiac disease occurrence, or vitamin D status. A greater number of remitters were in puberty compared to non-remitters (86.4% vs. 60.8%, p = 0.006). LDL-C concentration was similar in prepubertal remitters vs. non-remitters (p = 0.93), but was significantly lower in remitters in puberty compared to non-remitters in puberty (p = 0.018) after adjusting for age and duration of diabetes.ConclusionsChildren with type 1 diabetes who underwent a honeymoon phase had significantly lower LDL cholesterol 5 years after diagnosis. This early divergence in lipidemia may explain the dichotomy in the prevalence of long-term complication in type 1 diabetes between remitters and non-remitters. It also offers a pathway for targeted lipid monitoring in type 1 diabetes, by establishing non-remission as a non-modifiable risk factor for vascular complication in type 1 diabetes.

Remission phase in children diagnosed with type 1 diabetes in years 2012 to 2013 in Silesia, Poland: An observational study

“…PR is not only a potential time for intervention but also may be considered as a factor beneficial for the course of the disease from the clinical point of view . During our study, we observed that patients who achieved remission in the past present lower HbA1c values (better metabolic control) 4 years after diagnosis.…”

“…PR is not only a potential time for intervention but also may be considered as a factor beneficial for the course of the disease from the clinical point of view. 27 During our study, we observed that patients who achieved remission in the past present lower HbA1c values (better metabolic control) 4 years after diagnosis. Similar conclusions were presented by a study conducted by Abdul et al 3 This observation requires however further investigation as recently published data are opposite and showed now differences in anthropometric parameters in children 5 years after T1D diagnosis.…”

Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes

“…Two recent studies conducted in the U.S. showed lower the remissions rates. Particularly, Marino et al reported 42.8% of remitters among 204 young patients (2–14 years) who were retrospectively analyzed, whereas 35.8% of remitters were described in another longitudinal retrospective study including 123 subjects with T1D of 4–5 years of duration [ 26 , 27 , 28 ]. In Poland, PCR prevalence was estimated in 61.8% of 186 patients newly diagnosed with T1D and followed-up over 24 months and in 59% of 194 children with at least 4 years of T1D duration [ 2 , 29 ].…”

Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents from Wielkopolska province in Poland: prevalence, risk factors and clinical presentation

“…On the other hand, DKA has a negative influence on a residual b-cell function, therefore, patients with DKA at T1D onset had a lower partial remission incidence in the first six months after diagnosis [15], less a residual b-cell function and have a worse metabolic control [16]. Those individuals who developed partial remission had significantly lower level of low-density lipoprotein (LDL) 5 years after T1D diagnosis [17].…”