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

Abstract

Type 1 diabetes mellitus (T1DM) is characterized by irreversible islet β cell destruction. During the progression of this disease, some patients with T1DM experience a phase of remission known as honeymoon or partial remission (PR) that is mainly characterized by satisfactory glycemic control and the transient recovery of islet β cell function. This special phase is a good model for studying the mechanism of β cell protection, might serve as a proper intervention period for immunotherapy, and may be related to disease prognosis. This special stage is highly valuable for studies aiming to identify possible targets that may be used to cure T1DM. An in-depth understanding of the diagnosis, epidemiology, and possible mechanisms of the PR phase is highly needed. In general, patients enter the PR phase approximately 3 months after starting insulin therapy, and this phase could be sustained for 6 to 9 months. Current research increasingly focuses on the metabolic and immunological aspects to constantly update our understanding of this phase. This review concentrates on the PR phase of T1DM to provide a comprehensive outlook of its epidemiology, diagnostic criteria, and underlying immune metabolic mechanisms. KEYWORDSimmuno-metabolic mechanism, remission phase, the honeymoon period, type 1 diabetes

Frequency, clinical characteristics, and determinants of partial remission in type 1 diabetes: Different patterns in children and adults

“…19 But large differences were observed among countries, from 2.9% in Kuwait 20 to 90% in Poland. 17 A study reported a rate of approximately 42% in the USA, and about twothirds of children and adolescents with T1D in Germany had developed PR, which is similar to our results. 21 The specific reasons for these differences are not clear yet; the different study populations or different definitions of PR provide part of the reasons.…”

“…2 The important clinical significance and the different patterns of PR between juvenile and adult individuals should be emphasized because individuals in PR provide a suitable human cohort for investigating promising intervention targets for T1D. 17,18 However, data on differences between juveniles and adults are limited. Here, we reported that children and adults with T1D had different patterns on PR frequency, clinical characteristics, and determinants.…”

“…Although our results presented the whole picture of PR at all ages, the clinical features of PR in children had been showed in a few cross-sectional studies which demonstrated that the proportion of PR was quite varied in different countries and regions. 17 A multicenter study, the Glucose Evaluation Trial for Remission (GETREM), reported that only 11.6% of patients went into PR. 19 But large differences were observed among countries, from 2.9% in Kuwait 20 to 90% in Poland.…”

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

“…During the progression of the disease, some patients experience a phase of remission known as "honeymoon" or Partial Clinical Remission phase [2]. It is a transitory period that is marked by significant amount of endogenous insulin production by residual β cells following diabetes mellitus diagnosis and initiating the insulin therapy.…”

Risk factors for type 1 diabetes, including environmental, behavioural and gut microbial factors: a case–control study

“…To date, a typical T1D-associated microbiota has not been identified 23 – 26 . The research also determined that T1D clinical management could be improved by in-depth analysis of the partial remission phase 27 ; however, preventive measures are limited and generally focus only on genetic susceptibility 28 and general population screening for islet autoimmunity 29 . The development of an integrated prediction strategy could be useful for increasing early diagnosis while avoiding onset complications by identifying children at risk of T1D to place under observation and, in the future, to treat with preventive methods 10 .…”