'The honeymoon phase' in children with type 1 diabetes mellitus: frequency, duration, and influential factors

Abdul-Rasoul, Majedah; Habib, Hessa; Alkhouly, M

doi:10.1111/j.1399-543x.2006.00155.x

Cited by 206 publications

(278 citation statements)

References 28 publications

(66 reference statements)

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“…Honeymoon effect shortly after diagnosis onset is frequently described in T1DM [11]. However, normoglycemia and insulinfreedom maintained across 19 months in our patient may indicate that the patient is well beyond the honeymoon period and that the autoimmune process destructing the insulin secreting beta cells of the pancreas was halted or reversed.…”

Section: Discussionmentioning

confidence: 50%

A child with type 1 diabetes mellitus (T1DM) successfully treated with the Paleolithic ketogenic diet: A 19-month insulin-freedom

Tóth¹,

Clemens²

2015

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes SUMMARYType 1 diabetes mellitus (T1DM) is a chronic disease resulting from autoimmune destruction of insulin secreting beta cells of the pancreas. Worldwide the number of new T1DM cases is on a continuous rise despite extensive research efforts during the past decades. Patients with T1DM require lifelong insulin replacement. Currently T1DM patients are put on a high carbohydrate/ low fat diet, a practice which has recently been criticized by several investigators. Here we report our second case of T1DM successfully treated with the paleolithic ketogenic diet, an animal meat-fat based diet, which is the opposite of the standard diabetes diet in several respects. The 9-year-old child initially followed the traditional diabetes diet with insulin replacement. After six weeks the child switched to the paleolithic ketogenic diet under our close control. He was able to discontinuate insulin while maintaining normoglycemia. Stimulated C peptide level was in the normal range at 14 months after diet onset. Currently he is on the diet and is without insulin for 19 months which is well beyond the "honeymoon" period. While on the paleolithic ketogenic diet subsequent laboratory work ups were normal and no side effects emerged. Following the dietary shift his eczema disappeared, the number of upper respiratory infections greatly reduced and improved physical fittness was noted. We assume that in new-onset cases of T1DM adopting the paleolithic ketogenic diet may be feasible and effective in managing this condition. It seems that the autoimmune process may halt when strictly adhering to the diet.(This page in not part of the published article.)

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Section: Discussionmentioning

confidence: 50%

A child with type 1 diabetes mellitus (T1DM) successfully treated with the Paleolithic ketogenic diet: A 19-month insulin-freedom

Tóth¹,

Clemens²

2015

IJCRI

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“…The apoptosis levels of CD4 + CD25 +high T cells were stable in control subjects but transiently high in subjects with recentonset T1D. During the period immediately after the onset of T1D, many individuals develop partial remission of diabetes characterized by reduction in TDD, as the remaining beta cells, not exposed to excess glucose, continue to produce insulin, while the immune cell attack on the beta cells continues unabated [16]. Age-independent high levels of CD4 + CD25 +high T cell apoptosis during the relatively short time after the onset of the disease may parallel the autoimmune destruction of beta cells, and is detected during T1D remission only.…”

Section: Discussionmentioning

confidence: 94%

“…It has already been acknowledged that this period, when most subjects show reduced need for exogenous insulin, is an optimal time for immune intervention in human clinical trials for T1D [2,3,[16][17][18]. However, there are immunemodulating protocols in secondary prevention of T1D (see TRIALNET) that do not take the remission period into consideration, perhaps because of the difficulty in its definition.…”

Section: Discussionmentioning

confidence: 99%

“…The duration of the remission period is under the control of many factors that influence glycaemic control. Depending on age, pubertal status, insulin sensitivity and criteria for partial remission, up to 60% of patients with T1D might experience a partial remission [4,16,[18][19][20][21]. Furthermore, partial remission has been shown to be a heterogeneous phenomenon with inter-and intraindividual variation [22] and factors such as diabetes care intensity and early identification of hyperglycaemic symptoms prior to diagnosis influencing its course [20].…”

Section: Discussionmentioning

confidence: 99%

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Dynamic changes in CD4+ CD25+ high T cell apoptosis after the diagnosis of type 1 diabetes

Glisic-Milosavljevic

Wang

Koppen

et al. 2007

Clinical and Experimental Immunology

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SummaryBecause type 1 diabetes (T1D) is a chronic, autoimmune, T cell-mediated disease, interventions affecting T cells are expected to modulate the immune cascade and lead to disease remission. We propose that increased CD4 + CD25 +high T cell apoptosis, a trait we discovered in recent-onset T1D subjects, reflects T1D partial remission within the first 6 months after diagnosis. Apoptosis of forkhead box P3 (FoxP3) + CD4 + CD25 +high T cells, in addition to total daily doses of insulin (TDD), blood glucose, HbA1c and age, were measured in 45 subjects with T1D at various times after diagnosis. Sixteen healthy control subjects were also recruited to the study. Higher CD4 + CD25 +high T cell apoptosis levels were detected within the first 6 months of diagnosis (odds ratio = 1·39, P = 0·009), after adjustment for age, TDD and HbA1c. A proportional hazards model confirmed that the decline of apoptosis after diagnosis of T1D was related significantly to survival time (hazards ratio = 1·08, P = 0·014), with TDD and age also contributing to survival. During this time there was an inverse relationship between CD4+ CD25 +high T cell apoptosis with TDD (r = -0·39, P = 0·008). The CD4 + CD25 +high T cell apoptosis levels decline significantly after the first 6 months from diagnosis of T1D and may help in the close monitoring of autoimmunity. In parallel, there is an increase in TDD during this time. We also propose that CD4 + CD25 +high T cell apoptosis assay can be used to gauge the efficacy of the several immune tolerance induction protocols, now under way.

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“…Unfortunately, the first presentation of 10% to 70% of newly diagnosed children with DM1 is DKA (6). Also, these children encounter more problems than those newly diagnosed with DM1 including lower remission rate and poorer glycemic control (7,8).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis

Mirsadraee¹,

Khajedaluee²,

Vakili³

et al. 2016

J Pediatr Rev

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Background: Diabetes mellitus type 1 is one of the most prevalent endocrine diseases in pediatrics. Diabetic ketoacidosis is considered as one of the most threatening clinical pictures of DM1, especially if occurred as the first presentation of DM1 in children. Objectives: The current study aimed to identify factors which may play a role in DKA onset in children. Methods: This case-control study included all patients under 18 years old who referred to department of pediatrics endocrinology at Mashhad University Hospital (Imam Reza) from January 2013 to December 2015 as newly diagnosed patients with DM1. Patients who fulfilled DKA criteria at diagnosis were considered as DKA group and those who referred with other presentations were considered as control group (non-DKA group). Data were analyzed by SPSS software ver. 16. Results: During the study period, 97 (39.2% male) newly diagnosed patients were included as DKA group. Accordingly 97 genderand age-matched patients were added as non-DKA group. The most prevalent symptoms in both groups were polyuria (91.88%) and polydipsia (88.66%). Fever and cold symptoms were significantly higher in the DKA group (P < 0.001 and P =0.005, respectively). Hemoglobin A1c level was significantly higher in the DKA group (P = 0.001), while body mass index was significantly lower in the DKA group (P = 0.045). Fever and father's education level were the most important risk and protective factors in the DKA onset in newly diagnosed patients with DM1 (adjusted OR = 10.1, 95% CI = 2.9-35.3; P < 0.001 and adjusted OR = 0.5, 95% CI = 0.3 -0.9 and P = 0.019, respectively). Conclusions:In conclusion, a recent febrile illness was found as the strongest risk factor and father's education level as the main protective factor in the DKA to diagnose children with DM1. The study findings suggested that DKA is a severe form of DM1 instead of a neglected or misdiagnosed disease.

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'The honeymoon phase' in children with type 1 diabetes mellitus: frequency, duration, and influential factors

Cited by 206 publications

References 28 publications

A child with type 1 diabetes mellitus (T1DM) successfully treated with the Paleolithic ketogenic diet: A 19-month insulin-freedom

A child with type 1 diabetes mellitus (T1DM) successfully treated with the Paleolithic ketogenic diet: A 19-month insulin-freedom

Dynamic changes in CD4+ CD25+ high T cell apoptosis after the diagnosis of type 1 diabetes

Factors Associated with Newly Diagnosed Children with Diabetic Ketoacidosis

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