Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Abstract

Possibilities of prolonging endogenous insulin production during the "remission phase" of type 1 diabetes (T1DM) have been the focus of much interest in recent research. The aim of the study was to describe the course of clinical remission in children with new-onset type 1 diabetes and to compare the selected markers affecting the presence of partial clinical remission (CR), focusing, among others, on physical activity before/during diagnosis. Material and methods: We recruited 82 children (aged 10 ±3.72 years) with T1DM. We gathered data regarding the course of the disease (two years of observation), insulin treatment, and laboratory results. Endogenous insulin production was assessed on the basis of C-peptide fasting and prandial level. Remission of diabetes was defined according to actual criteria. Information about physical activity (PA) was obtained by telephone interview. Results: Patients with no physical activity, in comparison with those with a high level of PA before the diagnosis, had significantly worse parameters of acid-base balance at admission (p < 0.05). Patients with a higher PA level in the course of T1DM had significantly lower insulin requirements three months after diagnosis (p < 0.05). Patients < 10 years of age presented worse acid-base balance parameters (p < 0.05) at admission, lower fasting and postprandial C-peptide concentrations at admission (p < 0.05) and after two years of observation (p = 0.00), compared to the > 10-year-old group. In a follow-up lower insulin dose on the day of discharge and after 6 and 12 months, and higher postprandial C-peptide concentration was observed in patients with HbA 1c below 11.3% (median) at admission compared to the group with HbA 1c above 11.3%. Patients with remission at discharge from hospital presented fewer metabolic disturbances at admission (p < 0.05) and lower insulin requirements from the date of discharge (p = 0.00) to the end of the first year (p < 0.05). Conclusions: Lower insulin demand at discharge from hospital after diagnosis of T1DM in a child is connected with older age, lower HbA 1c level, and better clinical condition at admission. Higher PA affects better biochemical parameters at diagnosis of T1DM and lower demand for insulin later. During the first two years of the disease clinical remission may be connected with higher physical activity, but longitudinal studies are still required.

Body mass index and partial remission in 119 children with type 1 diabetes—a 6-year observational study

“…Among the studied population, we did not find any case of complete remission, which is consistent with some previous studies (2,4,21). However, some other authors reported complete remission cases (10,23,25).…”

“…Most often, the symptoms of type 1 diabetes mellitus (T1D), caused by progressive, autoimmune destruction of pancreatic β-cells leading to insulin deficiency, appear when more than 70% of β-cells are damaged ( 1 ). This destruction begins several years before the clinical diagnosis of diabetes, but some of these cells can still be functional even decades after the onset ( 2 – 4 ) with detectable C-peptide after as long as 50 years of diabetes ( 5 ).…”

C-peptide and residual β-cell function in pediatric diabetes – state of the art

“…In both studies, the influence of exercise on C-peptide secretion was marked. [52,53] PA related health benefits in T1D are indisputable, and it should be advised as a part of routine management in all patients since diabetes onset. Exercise not only promotes fitness but also reduces daily insulin demand, improves lipid profile, endothelial function and overall well-being, finally resulting in reduction of cardiovascular risk and mortality.…”

Excessive BMI is associated with higher C-peptide level at recognition but also with its greater loss in two years clinical observation in children with new onset type 1 diabetes

“…Moreover, C-peptide levels presented in some studies as an independent factor of partial remission and is correlated with its duration ( 13 , 14 ). The phenomenon of partial remission (PR), also known as the honeymoon phase, occurs in a number of patients who experience a transient reduction in insulin requirements in parallel with achieving proper metabolic control after the initiation of effective insulin therapy ( 15 ). PR is defined as a daily insulin requirement (DIR) of <0.5 units per kg of body weight and HbA1c <7% ( 16 ).…”