Remission phase in children diagnosed with type 1 diabetes in years 2012 to 2013 in Silesia, Poland: An observational study

Abstract

Background/Objective The study aimed to analyze the frequency of partial remission (PR) and its association with chosen clinical and laboratory factors among pediatric patients with newly diagnosed type 1 diabetes (T1D). The long‐term effect of PR on chosen parameters was also investigated. Methods In 194 patients (95 girls) aged 8.1 ± 4.3 years, we analyzed data at T1D onset: glycemia, pH, C‐peptide, antibodies, weight, and concomitant autoimmune diseases. Anthropometric parameters, daily insulin requirement (DIR), and HbA1c 2 and 4 years after T1D diagnosis were also analyzed. We determined PR based on HbA1c and DIR measurements at least every 3 months. Results PR occurred in 59% of patients. Remitters had significantly higher pH (7.33 vs 7.28, P = 0.03), weight SD score (SDS) (0.25 vs −0.24, P = 0.002), and body mass index SDS (0.19 vs −0.66, P = 0.02) compared with non‐remitters. Concomitant diseases correlated negatively with PR. Multivariate analysis indicated only pH at onset was an independent predictor of PR. pH was the most important factor associated with the beginning of PR. There was a positive correlation between the start and duration of PR. Four years after T1D onset remitters had lower HbA1c (7.24% vs 8.05%, 53 vs 63.9 mmol/mol, P < 0.001) and DIR (0.81 vs 1.08, P = 0.005). Conclusions PR occurred quite often and developed more frequently in children with higher: weight and BMI SDS, but the main factor influencing PR presence and duration was higher pH at T1D onset. There was a beneficial impact of PR on HbA1c and DIR after 4 years of treatment.

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

“…Patients who achieved the PCR had lower HbA1c levels over the 24-monthfollow-up period. Similar conclusions were also reported by other authors [ 21 , 29 ]. These findings further confirm the need to identify with certainty clinical and laboratory biomarkers, which are associated with PCR in order to ensure a better metabolic control for patients with T1D from the first years of disease.…”

“…Particularly, Marino et al reported 42.8% of remitters among 204 young patients (2–14 years) who were retrospectively analyzed, whereas 35.8% of remitters were described in another longitudinal retrospective study including 123 subjects with T1D of 4–5 years of duration [ 26 , 27 , 28 ]. 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 ].…”

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

“… 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 . Therefore, the role of gender in the PR phase remains unclear.…”

Combined vitamin D, ibuprofen and glutamic acid decarboxylase-alum treatment in recent onset Type I diabetes: lessons from the DIABGAD randomized pilot trial

“…As baseline clinical and immunological characteristics differed between the treatment arms, in order to see if using data after the well-known ‘honeymoon period’ would be as or more informative than the conventional baseline, we investigated the use of C-peptide data collected at 6 months of treatment as baseline. We chose 6 months even though we are aware of that duration of partial remission varies in different studies [ 47 , 48 ]. Our findings suggest that this strategy might possibly be informative to estimate the efficacy diminishing the consequence of baseline situation and should be further explored with larger number of patients.…”