Importance>50% of patients with new-onset type 1 diabetes (T1D) do not enter partial clinical remission (PCR); early identification of these patients may improve initial glycemic control and reduce long-term complications.AimTo determine whether routinely obtainable clinical parameters predict non-remission in children and adolescents with new-onset T1D.Subjects and methodsData on remission were collected for the first 36 months of disease in 204 subjects of ages 2–14 years with new-onset type 1 diabetes. There were 86 remitters (age 9.1±3.0y; male 57%), and 118 non-remitters (age 7.0±3.1y; male 40.7%). PCR was defined as insulin-dose adjusted hemoglobin A1c of ≤9.ResultsNon-remission occurred in 57.8% of subjects. Univariable analysis showed that the risk for non-remission was increased 9-fold in patients with 4 diabetes-associated auto-antibodies (OR = 9.90, p = 0.010); 5-fold in patients <5 years old (odds ratio = 5.38, p = 0.032), 3-fold in those with bicarbonate of <15 mg/dL at diagnosis (OR = 3.71, p = 0.008). Combined estimates of risk potential for HC03 and the number of autoantibodies by multivariable analysis, adjusted for BMI standard deviation score, showed HC03 <15 mg/dL with a clinically significant 10-fold risk (OR = 10.1, p = 0.074); and the number of autoantibodies with a 2-fold risk for non-remission (OR = 1.9, p = 0.105). Male sex and older age were associated with decreased risk for non-remission. A receiver-operating characteristic curve model depicting sensitivity by 1-specificity for non-remission as predicted by bicarbonate <15 mg/dL, age <5y, female sex, and >3 diabetes-associated autoantibodies had an area under the curve of 0.73.ConclusionsMore than 50% of children and adolescents with new-onset T1D do not undergo partial clinical remission and are thus at an increased risk for long-term complications of diabetes mellitus. A predictive model comprising of bicarbonate <15 mg/dL, age <5y, female sex, and >3 diabetes-associated autoantibodies has 73% power for correctly predicting non-remission in children and adolescents with new-onset T1D. Early identification of these non-remitters may guide the institution of targeted therapy to limit dysglycemia and reduce the prevalence of long-term deleterious complications.

There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA1c of ≤9 or TDD of <0.3 units/kg/day.

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Background Sport and exercise medicine (SEM) is a relatively new specialty, and it is not well incorporated into undergraduate medical education. Previous studies have highlighted that medical students would benefit from increased teaching on SEM, and that students would like more SEM teaching. The aim of this project is to establish which SEM-related topics are deemed to be most important to incorporate into undergraduate medical education and confirm whether medical students would benefit from increased SEM exposure. Methods An online survey was distributed to all members of the British Association of Sport and Exercise Medicine (BASEM) via email, and it was shared on Twitter via BASEM and the research team. Results A total of 126 responses were analysed. The majority of respondents work in SEM, or were interested in pursuing a career in SEM. Musculoskeletal (MSK) examination skills, exercise to prevent and manage disease, and MSK injuries and conditions were deemed to be the most important SEM-related topics to teach medical students. Use of social media and pitchside case were deemed the least important. Respondents thought medical students do not receive enough SEM teaching at medical school and could benefit from increased SEM exposure. Conclusions This study supports the opinion that medical students would benefit from increased SEM exposure. This survey is the first to determine how important it is that specific SEM-related topics are taught to medical students. In response to this survey a Delphi study is being conducted in the UK to establish a consensus undergraduate SEM curriculum for medical students.

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