Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

Derraik, José G. B.; Jalaludin, Muhammad Yazid; Albert, Benjamin B.; Ramkumar, S; Cutfield, Wayne S.; Hofman, Paul L.; Jefferies, Craig

doi:10.1111/pedi.12881

Cited by 16 publications

(18 citation statements)

References 31 publications

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“…In Poland, PCR prevalence was estimated in 61.8% of 186 patients newly diagnosed with T1D and followed-up over 24 months and in 59% of 194 children with at least 4 years of T1D duration [ 2 , 29 ]. Chiavaroli et al reported an overall rate of partial remission at 3 months of 42.4% in a cohort study of 678 New Zealand patients aged <15 years [ 30 ]. A report from Sweden described a rate of 80% of remitters among 149 children and adolescents (0–16 years) with new-onset of T1D [ 9 ].…”

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

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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: 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

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“…And timely PR diagnosis facilitates adjustments of the therapy, so as to prevent acute events during the first year of T1D (19). Though PR only lasts for no more than a year, the occurrence of PR can also help with the prediction of long-term diabetes complications in T1D patients (3)(4)(5)20).…”

Section: Discussionmentioning

confidence: 99%

“…During the progression of this disease, some of the newly diagnosed patients might experience a special period termed as the partial remission (PR) phase, which is characterized by satisfactory glycemic control with reduced daily insulin requirements and the transient restoration of b cell function (2). The improved glycemic control during the PR calls for an adjustment of the insulin regiment in order to avoid acute events, and the presence of PR phase is associated with a lower risk of developing chronic complications (3)(4)(5). Therefore, it is of great clinical and research significance to guarantee the diagnostic accuracy of PR.…”

Section: Introductionmentioning

confidence: 99%

Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes

Shi

Xie

et al. 2022

Front. Endocrinol.

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ObjectiveTo propose a new definition of partial remission (PR) for patients with type 1 diabetes (T1D) of all-ages using insulin dose and glycated albumin (GA), and find the optimal cut-off values for stimulated C-peptide to diagnose PR in different age-groups.Research Design and MethodsPatients with newly diagnosed T1D (n=301) were included. GA/insulin dose was used to diagnose PR, and insulin dose-adjusted glycated albumin (IDAGA) was proposed to facilitate clinical application. The optimal diagnostic levels of IDAGA and stimulated C-peptide were determined in different age-groups (≤ 12y, 12-18y and ≥ 18y). Furthermore, the diagnostic consistency between different PR definitions was studied.ResultsGA≤ 23%/insulin dose ≤ 0.5u/kg/day was used to define PR, and IDAGA (GA (%) + 40 * insulin dose(u/kg/day)) ≤ 40 was feasible in all age-groups. Whereas, the optimal diagnostic level showed difference for stimulated C-peptide (265.5, 449.3 and 241.1 pmol/L for the ≤ 12y, 12-18y and ≥ 18y age-group, respectively). About 40% of patients met the PR definition by stimulated C-peptide but not GA/insulin dose or IDAGA, who showed dyslipidemia and higher insulin resistance.ConclusionsA new definition of the PR phase is proposed using GA/insulin dose, and the calculated IDAGA≤ 40 applies to all age-groups. The stimulated C-peptide to diagnose PR is the highest in the 12-18y age-group, which reflects the effect of puberty on metabolism. For patients with insulin resistance, it is not recommended to use stimulated C-peptide alone to diagnose PR.

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“…New parameters are needed to define the PRP or preserved beta-cell reserve period. Although several studies [11][12][13] focused on the PRP and investigated PRPrelated factors, data related to the glycemic parameters during the PRP are limited. Meng et al examined the relationship between blood glucose fluctuations during various phases of diabetes and oxidative stress and showed that the mean glucose, glucose SD, the mean amplitude of glycemic excursions (MAGE) and incremental area under the blood glucose curve (IAUC) levels during the PRP were lower than those during the acute metabolic disturbance and long-standing phases [14].…”

Section: Discussionmentioning

confidence: 99%

A comparison of glycemic parameters and their relationship with C-peptide and Proinsulin levels during partial remission and non-remission periods in children with type 1 diabetes mellitus - a cross-sectional study

et al. 2021

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Background Currently, there is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The aim of this study was to evaluate glycemic parameters in children with T1D who are in the PRP using intermittently scanned continuous glucose monitoring systems (isCGMS) and to investigate any relationships between CP and PI levels. Methods The study included 21 children who were in the PRP and 31 children who were not. A cross-sectional, non-randomized study was performed. Demographic, clinical data were collected and 2 week- isCGMS data were retrieved. Results The Serum CP showed a positive correlation with time-in-range in the PRP (p:0.03), however PI showed no correlations with glycemic parameters in both periods. The Serum CP and PI levels and the PI:CP ratio were significantly higher in the PRP group than in the non-PRP group. In the non-PRP group, the PI level was below 0.1 pmol/L (which is the detectable limit) in only 2 of the 17 cases as compared with none in the PRP group. Similarly, only 2 of the 17 children in the non-PRP group had CP levels of less than 0.2 nmol / L, although both had detectable PI levels. Overall time-in-range (3. 9-1.0 mmol/L) was significantly high in the PRP group. In contrast, the mean sensor glucose levels, time spent in hyperglycemia, and coefficient of variation levels (32.2vs 40.5%) were significantly lower in the PRP group. Conclusions Although the mean glucose and time in range during the PRP was better than that in the non-PRP group, the glycemic variability during this period was not as low as expected. While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters. Further studies are needed to determine if PI might prove to be a useful parameter in clinical follow-up.

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Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

Cited by 16 publications

References 31 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

Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes

A comparison of glycemic parameters and their relationship with C-peptide and Proinsulin levels during partial remission and non-remission periods in children with type 1 diabetes mellitus - a cross-sectional study

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