Factors Influencing Frequency and Duration of Remission in Children and Adolescents Newly Diagnosed with Type 1 Diabetes

Kara, Özlem; Esen, İhsan; Tepe, Derya

doi:10.12659/msm.908450

Cited by 12 publications

(20 citation statements)

References 22 publications

(40 reference statements)

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“…Therefore, the process leading to the achievement of PCR seems to be so precocious as to allow a prompt reduction of the daily insulin dose from the first days of the disease. Similarly to our study, Kara et al found that remitter patients also had lower basal insulin requirements, suggesting that patients who entered the PCR could easily meet their basal insulin requirements due to residual endogenous insulin secretion in the early phase of the disease [ 37 ].…”

Section: Discussionsupporting

confidence: 83%

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

Passanisi

Salzano

Gasbarro

et al. 2020

IJERPH

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Partial clinical remission (PCR) is a transitory period characterized by the residual endogenous insulin secretion following type 1 diabetes (T1D) diagnosis and introducing the insulin therapy. Scientific interest in PCR has been recently increasing, as this phase could be crucial to preserve functional beta cells after T1D onset, also taking advantage of new therapeutic opportunities. The aim of this study was to assess the frequency, duration and associated factors of PCR in children newly diagnosed with T1D. Our cohort study included 167 pediatric patients aged 13.8 ± 4.1 years. The association of clinical and laboratory factors with the occurrence and duration of PCR was evaluated via logistic regression and multivariable generalized linear model, respectively. PCR occurred in 63.5% of the examined patients. Patients who achieved the remission phase were significantly older, and they had lower daily insulin requirement compared with non-remitters. PCR was positively associated to body mass index (OR = 1.11; p = 0.032), pH value (OR 49.02; p = 0.003) and c-peptide levels (OR 12.8; p = 0.002). The average duration of PCR was 13.4 months, and older age at diagnosis was the only predictor factor. Two years after diagnosis remitter patients had lower HbA1c and daily insulin requirement.

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Section: Discussionsupporting

confidence: 83%

“…It is known that puberty is characterized by physiological decreased insulin sensitivity. However, previous studies reported conflicting results on the real influence of pubertal stage in determining the occurrence of PCR [ 37 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

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

Passanisi

Salzano

Gasbarro

et al. 2020

IJERPH

View full text Add to dashboard Cite

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“…In addition, adolescence seems to be a dividing line. The remission rates among young children before puberty have been shown to be significantly lower than those among postpubescent patients . This difference might be due to the existence of the different mechanisms responsible for entering the PR phase.…”

Section: Factors Affecting the Pr Phasementioning

confidence: 98%

“…One predictive model suggested that severe diabetic acidosis (bicarbonate <15 mg/dL), a younger onset age (<5 years), female sex, and multiple diabetes‐associated autoantibodies had a high predictive value of 73% in patients who did not experience a PR phase Gender Some studies have reported that male patients were more likely to develop PR than females and to remain in PR for a longer duration . However, in some studies, no significant sex‐dependent difference in duration was found .…”

Section: Factors Affecting the Pr Phasementioning

confidence: 99%

The remission phase in type 1 diabetes: Changing epidemiology, definitions, and emerging immuno‐metabolic mechanisms

Zhong

Tang

Gong

et al. 2019

Diabetes Metabolism Res

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Type 1 diabetes mellitus (T1DM) is characterized by irreversible islet β cell destruction. During the progression of this disease, some patients with T1DM experience a phase of remission known as honeymoon or partial remission (PR) that is mainly characterized by satisfactory glycemic control and the transient recovery of islet β cell function. This special phase is a good model for studying the mechanism of β cell protection, might serve as a proper intervention period for immunotherapy, and may be related to disease prognosis. This special stage is highly valuable for studies aiming to identify possible targets that may be used to cure T1DM. An in-depth understanding of the diagnosis, epidemiology, and possible mechanisms of the PR phase is highly needed. In general, patients enter the PR phase approximately 3 months after starting insulin therapy, and this phase could be sustained for 6 to 9 months. Current research increasingly focuses on the metabolic and immunological aspects to constantly update our understanding of this phase. This review concentrates on the PR phase of T1DM to provide a comprehensive outlook of its epidemiology, diagnostic criteria, and underlying immune metabolic mechanisms. KEYWORDSimmuno-metabolic mechanism, remission phase, the honeymoon period, type 1 diabetes

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“…Previously published studies have shown significant associations between age ( 11 , 64 – 68 ) and partial remission. Consistent with these findings, we show that the probability of remaining in remission (survival probability) is greater in patients who are older at diagnosis.…”

Section: Discussionmentioning

confidence: 89%

CD4+CD25+CD127hi cell frequency predicts disease progression in type 1 diabetes

Narsale¹,

Lam²,

Moya³

et al. 2021

JCI Insight

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Transient partial remission, a period of low insulin requirement experienced by most patients soon after diagnosis, has been associated with mechanisms of immune regulation. A better understanding of such natural mechanisms of immune regulation might identify new targets for immunotherapies that reverse type 1 diabetes (T1D). In this study, using Cox model multivariate analysis, we validated our previous findings that patients with the highest frequency of CD4 + CD25 + CD127 hi (127-hi) cells at diagnosis experience the longest partial remission, and we showed that the 127-hi cell population is a mix of Th1- and Th2-type cells, with a significant bias toward antiinflammatory Th2-type cells. In addition, we extended these findings to show that patients with the highest frequency of 127-hi cells at diagnosis were significantly more likely to maintain β cell function. Moreover, in patients treated with alefacept in the T1DAL clinical trial, the probability of responding favorably to the antiinflammatory drug was significantly higher in those with a higher frequency of 127-hi cells at diagnosis than those with a lower 127-hi cell frequency. These data are consistent with the hypothesis that 127-hi cells maintain an antiinflammatory environment that is permissive for partial remission, β cell survival, and response to antiinflammatory immunotherapy.

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Factors Influencing Frequency and Duration of Remission in Children and Adolescents Newly Diagnosed with Type 1 Diabetes

Cited by 12 publications

References 22 publications

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

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

The remission phase in type 1 diabetes: Changing epidemiology, definitions, and emerging immuno‐metabolic mechanisms

CD4+CD25+CD127hi cell frequency predicts disease progression in type 1 diabetes

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