Glucose evaluation trial for remission (GETREM) in type 1 diabetes: a European multicentre study

Pozzilli, Paolo; Manfrini, Silvia; Buzzetti, Raffaella; Lampeter, E. F.; Leeuw, I. De; Iafusco, Dario; Prisco, María Cristina Di; Ionescu-Tîrgovişte, C; Koloušková, Stanislava; Linn, Thomas; Ludvigsson, Johnny; Madácsy, László; Mrozikiewicz, A; Pm, Mrozikiewicz; Podar, T; Vavřinec, J; Vialettes, B.; Visalli, N; Yılmaz, Temel; Browne, Pd

doi:10.1016/j.diabres.2004.10.001

Cited by 35 publications

(28 citation statements)

References 31 publications

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“…Similar to other studies [10, 11], even with different PR definitions [7, 12], we did not find gender differences. However, Dost et al reported longer PR in boys below 10 years of age [13], but in the same study PR durations were shorter for patients <10 years when the global cohort was analyzed.…”

Section: Discussionsupporting

confidence: 91%

Characteristics and Determinants of Partial Remission in Children with Type 1 Diabetes Using the Insulin-Dose-Adjusted A1C Definition

Pecheur

Barrea

Vandooren

et al. 2014

Journal of Diabetes Research

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To evaluate the characteristics and determinants of partial remission (PR) in Belgian children with type 1 diabetes (T1D), we analyzed records of 242 children from our center. Clinical and biological features were collected at diagnosis and during follow-up. PR was defined using the insulin-dose-adjusted A1C definition. PR occurred in 56.2% of patients and lasted 9.2 months (0.5 to 56.6). 25.6% of patients entered T1D with DKA, which correlated with lower PR incidence (17.6% versus 82.3% when no DKA). In our population, lower A1C levels at diagnosis were associated with higher PR incidence and in young children (0–4 years) initial A1C levels negatively correlated with longer PR. Early A1C levels were predictive of PR duration since 34% of patients had long PRs (>1 year) when A1C levels were ≤6% after 3 months whereas incidence of long PR decreased with higher A1Cs. C-peptide levels were higher in patients entering PR and remained higher until 3 years after diagnosis. Initial antibody titers did not influence PR except for anti-IA2 titers that correlated with A1C levels after 2 years. Presence of 2 versus 1 anti-islet antibodies correlated with shorter PR. PR duration did not influence occurrence of severe hypoglycemia or diabetes-related complications but was associated with lower A1C levels after 18 months. We show that, at diagnosis of T1D, parameters associated with β-cell mass reserve (A1C, C-peptide, and DKA) correlate with the occurrence of PR, which affects post-PR A1C levels. Further research is needed to determine the long-term significance of PR.

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Section: Discussionsupporting

confidence: 91%

Characteristics and Determinants of Partial Remission in Children with Type 1 Diabetes Using the Insulin-Dose-Adjusted A1C Definition

Pecheur

Barrea

Vandooren

et al. 2014

Journal of Diabetes Research

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“…A sustained honeymoon phase (i.e., lasting some years) and even a total remission of T1D have been reported as uncommon phenomena, especially in children [16, 48]. Although immunological changes during remission are poorly characterized [49], an extension of this stage may benefit T1D patients, since residual β-cell function has been associated with a reduction in long-term and acute complications [50].…”

Section: Clinical Perspectives: the Strength Of The Remission Phasementioning

confidence: 99%

Remission Phase in Paediatric Type 1 Diabetes: New Understanding and Emerging Biomarkers

Fonolleda¹,

Murillo²,

Vázquez

et al. 2017

Horm Res Paediatr

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Type 1 diabetes (T1D) is a metabolic disease of unknown aetiology that results from the autoimmune destruction of the β-cells. Clinical onset with classic hyperglycaemic symptoms occurs much more frequently in children and young adults, when less than 30% of β-cells remain. Exogenous insulin administration is the only treatment for patients. However, due to glucose dysregulation, severe complications develop gradually. Recently, an increase in T1D incidence has been reported worldwide, especially in children. Shortly after diagnosis, T1D patients often experience partial remission called “honeymoon phase,” which lasts a few months, with minor requirements of exogenous insulin. In this stage, the remaining β-cells are still able to produce enough insulin to reduce the administration of exogenous insulin. A recovery of immunological tolerance to β-cell autoantigens could explain the regeneration attempt in this remission phase. This mini-review focuses on the remission phase in childhood T1D. Understanding this period and finding those peripheral biomarkers that are signs of immunoregulation or islet regeneration could contribute to the identification of patients with a better glycaemic prognosis and a lower risk of secondary complications. This remission phase could be a good checkpoint for the administration of future immunotherapies.

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“…Previous descriptions usually divide remission phase into partial and complete, allowing complete insulin withdrawal, which is not practical now since current data suggest the benefit of continuing low-dose insulin therapy, unless its cessation is necessary to prevent hypoglycaemia [9]. Frequency of the partial remission phase was reported from 0 to 80 % [10], which reflects difficulty in comparison between studies resulting partly from adoption of various definitional criteria [11,12]. This could also be the important reason for which previous studies analysing factors influencing the occurrence and length of remission phase reached conflicting results.…”

Section: Discussionmentioning

confidence: 94%

Factors associated with early beginning of partial remission in young adult patients with newly diagnosed type 1 diabetes

Piłaciński

Zozulińska‐Ziółkiewicz

Uruski

et al. 2015

Int J Diabetes Dev Ctries

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Clinical remission of type 1 diabetes reflects the transient recovery of β-cell function and improvement in insulin sensitivity, occurring after introduction of insulin therapy. The aim of the study was to identify factors associated with early beginning of partial remission phase in patients with newly diagnosed type 1 diabetes. One hundred and sixteen patients (41 women and 75 men), aged 18-34 (mean age 23.8±8.7 years), were included into the study. Mean hospitalization time was 7±2 days. Early remission was defined as reaching total daily insulin dose <0.3 U/kg with correct glycaemia in 24-h (7-point) glycaemic profile before discharge from the hospital, with random serum Cpeptide above 0.5 μg/l. In group entering early remission (74 patients), significantly lower HbA1c values (9.6±2.6 vs. 11.5±4.5 %, p<0.001), higher body mass index (BMI) (21.9 ± 2.9 vs. 20.8 ± 4.2 kg/m 2 , p < 0.05), less frequent ketonuria (45 vs. 79 %, p<0.01) and diabetic ketoacidosis (11 vs. 26 %, p = 0.06) were recorded at diagnosis. The results indicate that degree and duration of metabolic disturbances are associated with early beginning of partial remission in young adults with newly diagnosed type 1 diabetes. Early onset of remission is common in this age group.

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Glucose evaluation trial for remission (GETREM) in type 1 diabetes: a European multicentre study

Cited by 35 publications

References 31 publications

Characteristics and Determinants of Partial Remission in Children with Type 1 Diabetes Using the Insulin-Dose-Adjusted A1C Definition

Characteristics and Determinants of Partial Remission in Children with Type 1 Diabetes Using the Insulin-Dose-Adjusted A1C Definition

Remission Phase in Paediatric Type 1 Diabetes: New Understanding and Emerging Biomarkers

Factors associated with early beginning of partial remission in young adult patients with newly diagnosed type 1 diabetes

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