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

Abstract

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.

Type one diabetes and autoimmune-related conditions: a Portuguese research in pediatric age

“…According to published data the prevalence of thyroiditis is approximately 3-8% and celiac disease ranges from 1 to 10% which is in line with our prevalence study (4% and 5% respectively) [5][6][7].…”

“…Around the Europe a few studies were published. An Italian study showed that the screening programming for detecting other autoimmune diseases is very critical in the first ten years after the onset of autoimmune diabetes, with 30% prevalence which overlaps with our results [6].…”

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

“…The longest mean duration (26.9 months) was previously described in Turkey [ 40 ]. Recently, a retrospective study showed that patients with a longer duration of PCR seem at risk of developing another autoimmune disease during a 10-year follow-up period after diagnosis [ 41 ]. Our results revealed that age at diagnosis was the only predictor of PCR duration.…”

Musa paradisiacaL. leaf and fruit peel hydroethanolic extracts improved the lipid profile, glycemic index and oxidative stress in nicotinamide/streptozotocin‐induced diabetic rats

“…Diabetes mellitus (DM) is a syndrome characterized by decreased insulin secretion and/or tissue insulin sensitivity and altered metabolism of carbohydrates, lipids and proteins, in addition to increased cardiovascular risks (Davis et al., 1996). Type 1 diabetes mellitus (T1DM) is characterized by irreversible and autoimmune pancreatic β ‐cell destruction (Ozen et al., 2020). Type 2 DM (T2DM) is the most incident form, responsible for 90% of the disease prevalence (Wild et al., 2004; World Health Organization, 2006).…”