Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes

Niedźwiecki, Paweł; Piłaciński, Stanisław; Uruska, Aleksandra; Adamska, Anna; Naskręt, Dariusz; Zozulińska−Ziółkiewicz, Dorota

doi:10.1016/j.jdiacomp.2015.09.002

Cited by 44 publications

(69 citation statements)

References 34 publications

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“…Clinical data indicate that patients with newly-diagnosed type 1 diabetes who undergo PCR have persistent C-peptide level, improved glycemic control in the short term (Fig 2), and reduced prevalence of diabetes complications in the long-term[2, 33]. However, up to 60% of patients with new-onset type 1 diabetes are non-remitters, and thus are not expected to experience these advantages in the life history of their disease[12, 13, 16].…”

Section: Discussionmentioning

confidence: 99%

“…Our dataset quantifies the glycemic cost of non-remission: in our cohort the HbA1c was significantly higher in non-remitters than remitters for an extended period spanning 3–18 months post diagnosis. Simple clinical parameters that indicate increased risk for non-remission are not fully characterized and there is no uniform strategy to identify these patients and prevent early dysglycemia that may have negative consequences later in life[2]. …”

Section: Discussionmentioning

confidence: 99%

“…Residual endogenous insulin secretion in patients with type 1 diabetes is associated with improved long-term glycemic control, reduced risk of severe hypoglycemia[8, 9], reduced risk for the development of diabetic retinopathy[10] and improved statural growth in prepubertal children[11]. A recent long-term study reported a significantly reduced risk for chronic microvascular complications at 7-year follow up in patients who entered PCR [2]. Thus, patients who undergo PCR, also known as remitters, have an overall prognostic advantage over non-remitters, but this is not usually taken into consideration during the early management of children who fail to undergo PCR.…”

Section: Introductionmentioning

confidence: 99%

“…This new approach is important, since available data report a prevalence of non-remission of 39–61% in a mixed population of pediatric and adult patients [12, 15], or as high as 65% in children and adolescents[1, 14]. The frequent occurrence of non-remission, the resulting inadequate early glycemic control, and the data linking non-remission with risk of complications[2] suggest that a detailed analysis of the factors that predict PCR may enable strategies to improve early glycemic control and reduce complications[2, 3]. In addition, early identification of non-remitters would enhance study subject selection or exclusion in beta-cell preservation trials, and ongoing monitoring data following diagnosis of type 1 diabetes for studies aimed at characterizing the prodromal phase of type 1 diabetes such as the TrialNet Consortium.…”

Section: Introductionmentioning

confidence: 99%

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A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes

et al. 2017

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Importance>50% of patients with new-onset type 1 diabetes (T1D) do not enter partial clinical remission (PCR); early identification of these patients may improve initial glycemic control and reduce long-term complications.AimTo determine whether routinely obtainable clinical parameters predict non-remission in children and adolescents with new-onset T1D.Subjects and methodsData on remission were collected for the first 36 months of disease in 204 subjects of ages 2–14 years with new-onset type 1 diabetes. There were 86 remitters (age 9.1±3.0y; male 57%), and 118 non-remitters (age 7.0±3.1y; male 40.7%). PCR was defined as insulin-dose adjusted hemoglobin A1c of ≤9.ResultsNon-remission occurred in 57.8% of subjects. Univariable analysis showed that the risk for non-remission was increased 9-fold in patients with 4 diabetes-associated auto-antibodies (OR = 9.90, p = 0.010); 5-fold in patients <5 years old (odds ratio = 5.38, p = 0.032), 3-fold in those with bicarbonate of <15 mg/dL at diagnosis (OR = 3.71, p = 0.008). Combined estimates of risk potential for HC03 and the number of autoantibodies by multivariable analysis, adjusted for BMI standard deviation score, showed HC03 <15 mg/dL with a clinically significant 10-fold risk (OR = 10.1, p = 0.074); and the number of autoantibodies with a 2-fold risk for non-remission (OR = 1.9, p = 0.105). Male sex and older age were associated with decreased risk for non-remission. A receiver-operating characteristic curve model depicting sensitivity by 1-specificity for non-remission as predicted by bicarbonate <15 mg/dL, age <5y, female sex, and >3 diabetes-associated autoantibodies had an area under the curve of 0.73.ConclusionsMore than 50% of children and adolescents with new-onset T1D do not undergo partial clinical remission and are thus at an increased risk for long-term complications of diabetes mellitus. A predictive model comprising of bicarbonate <15 mg/dL, age <5y, female sex, and >3 diabetes-associated autoantibodies has 73% power for correctly predicting non-remission in children and adolescents with new-onset T1D. Early identification of these non-remitters may guide the institution of targeted therapy to limit dysglycemia and reduce the prevalence of long-term deleterious complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes

et al. 2017

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“…The honeymoon period, and its contributory factors, have important clinical benefits. The occurrence of a honeymoon period per se is associated with fewer microvascular complications [8]. Improved insulin sensitivity is associated with fewer vascular complications [7].…”

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confidence: 99%

The Type 1 diabetes ‘honeymoon’ period is five times longer in men who exercise: a case–control study

et al. 2018

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Type 1 diabetes mellitus is an autoimmune disorder characterized by the destruction of insulin-secreting β cells, and subsequent insulin deficiency. Shortly after diagnosis, 60% of adults with Type 1 diabetes experience a period of partial remission, or 'honeymoon' period, characterized by low insulin requirement and good glycaemic control [1]. Historically, the honeymoon period was defined as an insulin requirement of ≤ 0.5 units/kg/day together with HbA ≤ 58 mmol/mol (7.5%). Currently, the honeymoon period is defined as insulin dose-adjusted A (IDAA ) ≤ 9, where IDAA = HbA (%) + [4× insulin dose (units/kg/day)] [2]. This shows good correlation with stimulated C-peptide, and therefore endogenous insulin secretion [2]. This article is protected by copyright. All rights reserved.

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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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Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes

Cited by 44 publications

References 34 publications

A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes

A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes

The Type 1 diabetes ‘honeymoon’ period is five times longer in men who exercise: a case–control study

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

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