Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of &lt;0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

Lundberg, Rachel L.; Marino, Katherine R.; Jasrotia, Aastha; Maranda, Louise; Barton, Bruce; Alonso, Laura; Nwosu, Benjamin Udoka

doi:10.1515/jpem-2017-0019

Cited by 28 publications

(45 citation statements)

References 31 publications

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“…e definition of the Partial Clinical Remission was normal glycemic values in the 24-hour profile together with daily insulin requirement <0.3°U/kg body weight/24 hours according to current Clinical Practice Guidelines [5].…”

Section: Methodsmentioning

confidence: 99%

“…Recent studies have enlightened that an appropriate treatment and follow-up during the honeymoon could potentially enable the prolongation of this period for years or even permanently stop the destruction of the remaining β cells. e patients who experienced Partial Clinical Remission phase or "honeymoon" period [5] have a significantly reduced risk of related long-term microvascular complications such as diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, increase in statural growth in prepubescent children and reduced risk of severe hypoglycemia, but the prevalence of Partial Clinical Remission in children is approximately 50%, and this means that a significant proportion of children with type 1 Diabetes Mellitus will not experience Partial Clinical Remission.…”

Section: Introductionmentioning

confidence: 99%

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The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon)

Ozen

Zanfardino

Confetto

et al. 2020

International Journal of Endocrinology

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Type 1 diabetes mellitus (DM) is characterized by irreversible, autoimmune, pancreatic β-cell destruction. During the disease, some patients experience a phase of Partial Clinical Remission (PCR) known as “honeymoon.” This is a transitory period that is characterized by insulin production by residual β cells following DM diagnosis and initiating the insulin therapy. In this study, we aimed to evaluate the influence of insulin production on immune system after the onset of diabetes, and we showed that the duration of honeymoon period could be related to the onset of other autoimmune conditions. For this retrospective study, 159 children aged between 11 and 18 years with type 1 DM were eligible. They have been diagnosed diabetes at least 10 years ago and use exogenous insulin. Our results showed that younger age at the onset of Type 1 DM in children, predicts Celiac Disease. Female sex and low HCO3 levels at the onset of DM had a high predictive value on patients who did not experience longer Partial Clinical Remission phase. Patients with higher BMI at the diagnosis of DM experienced shorter honeymoon period than the average. Smaller of our patients who diagnosed just DM have more than 297 days honeymoon period with respect to patients with one associated autoimmune disease. This may be due to a continuous and prolonged stimulation of immune system during the period of honeymoon that predispose the patient to develop other TH1 diseases. The patients who experienced more than 297 days Partial Clinical Remission seem under risk of developing one other autoimmune disease more than the patients who experienced less than 297 days Partial Clinical Remission. We have to consider that this observation is very intriguing because many protocols spring-up to try prolonging the honeymoon period in patients with autoimmune DM. If this aim is important from a metabolic point of view, long follow-ups are needed to be sure that the risk of other autoimmune diseases does not increase.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon)

Ozen

Zanfardino

Confetto

et al. 2020

International Journal of Endocrinology

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“…All children (ages 5‐19 years) with type 1 diabetes diagnosed at least 1 year prior to camp attendance in the 2016 and/or 2017 summer sessions were screened. Based on predefined criteria, campers were excluded if they: (a) had incomplete or missing data from camp, (b) were diagnosed with non‐type 1 diabetes mellitus, (c) were taking metformin, (d) were considered to be in the honeymoon phase (defined as having an insulin dose‐adjusted HbA1c ≤9% AND a total daily dose <0.3 units/kg/day), (e) were on regular, mixed, or intermediate‐acting insulins, (f) had other chronic medical conditions or recent medications that would be likely to affect blood glucose such as systemic corticosteroids, (g) had changes to their basal insulin that differed from the protocol for that year, including campers normally on CSII at home who switched to MDI at camp, (h) had any errors to their insulin dosing, or (i) were on the Medtronic 670G insulin pump. There were a total of 1306 camper sessions in 2016 and 2017 combined, of which 457 sessions were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…All children (ages 5-19 years) with type 1 diabetes diagnosed at least 1 year prior to camp attendance in the 2016 and/or 2017 summer sessions were screened. Based on predefined criteria, campers were excluded if they: (a) had incomplete or missing data from camp, (b) were diagnosed with non-type 1 diabetes mellitus, (c) were taking metformin, (d) were considered to be in the honeymoon phase (defined as having an insulin dose-adjusted HbA1c ≤9% AND a total daily dose <0.3 units/kg/day), 13…”

Section: Participantsmentioning

confidence: 99%

Impact of insulin reduction on glycemic control in children attending a residential diabetes camp

Adhikari

White

et al. 2019

Pediatr Diabetes

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Background/Objectives Children attending diabetes camp are more active, increasing the risk of hypoglycemia. Decreasing initial insulin doses may reduce this risk. The objectives of our study were to compare glycemic control between campers receiving multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and analyze the impact of decreasing basal insulin by 10%. Methods We analyzed 849 camp sessions (599 children, 5‐19 years old) from Camp Sweeney's 2016/2017 summers. Campers were separated into groups by year and insulin route (MDI_2016, MDI_2017, CSII_2016, and CSII_2017). The MDI_2016 group had initial basal insulin decreased 10%, while CSII_2016, MDI_2017, and CSII_2017 did not. Time spent in blood glucose ranges and area under the curve (AUC) were compared by year and insulin route using ANOVA. We also performed repeated measures ANOVA using campers who attended both years. Results No significant differences in time spent in any glucose range could be attributed to the initial 10% basal decrease, including on paired analysis. MDI_2017 had more decreases to basal insulin than the other groups. CSII campers had higher AUC and more hyperglycemia than MDI campers. Conclusions Campers on MDI may benefit from decreasing basal insulin, either at the beginning of camp or during the first week. Future research is needed to optimize glycemic control in the camp setting.

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“…This algorithm was validated in subsequent studies, and the IDAA 1c has prevailed as a measurement for partial remission [29][30][31][32][33]. It has also been proposed that a total daily dose of insulin of ≤0.3 U kg −1 day −1 performed equally well as IDAA 1c in predicting remission [34], though not thoroughly tested. In a study by Boyle et al, HbA 1c , insulin used or the combination of both, using IDAA 1c , were not reliable surrogates of beta cell function compared with C-peptide response to MMTT stimulation in individuals with type 1 diabetes [35].…”

Section: Modelling Residual Beta Cell Functionmentioning

confidence: 99%

Capturing residual beta cell function in type 1 diabetes

Pociot

2018

Diabetologia

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Since the 1970s, C-peptide has been used as a surrogate marker for monitoring the progression of type 1 and type 2 diabetes and to determine the effects of interventions designed to preserve or improve residual beta cell function. C-peptide measurement is a well-established surrogate of residual beta cell activity and of clinical significance as it is associated with HbA 1c , risk for microvascular complications and the incidence of hyperglycaemia in longitudinal studies. Measurement of C-peptide after a mixed meal tolerance test is considered the gold standard of measuring beta cell function in type 1 diabetes, but the method is laborious and inconvenient. In this issue of Diabetologia, Wentworth et al (https://doi.org/10.1007/s00125-018-4722-z) report an algorithm for estimating C-peptide (CP EST ) based on six routine clinical measures. These do not include stimulated C-peptide measurement and outperform other prevailing algorithms for estimating residual beta cell function. Going forward it is very likely that this new algorithm will serve as a simple measure of beta cell function in routine practice and as a more acceptable primary outcome measure in future trials of disease-modifying therapies.

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Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

Abstract: There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA1c of ≤9 or TDD of <0.3 units/kg/day.

Cited by 28 publications

References 31 publications

The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon)

The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon)

Impact of insulin reduction on glycemic control in children attending a residential diabetes camp

Capturing residual beta cell function in type 1 diabetes

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