Frequency of partial remission and related factors in children and adolescents diagnosed with type 1 diabetes mellitus

Abstract

The aim of this study was to determine the frequency of remission and related factors in children and adolescents with T1DM. The medical files of patients, diagnosed at our clinic with T1DM in a sequential 3-year period and followed up for at least one year, were retrospectively reviewed. Measurements of pH, blood glucose, insulin, C-peptide, HbA1c and diabetes related auto-antibodies were recorded at diagnosis along with presence of diabetic keto-acidosis and daily insulin requirements at initial discharge. Subsequent HbA1c values and daily insulin requirements were recorded at follow up visits. Partial remission was defined as the value of adjusted HbA1c of≤9. Adjusted HbA1c is equal to HbA1c (percent)+[4 x insülin dose (units per kilograms per day)]. Patients were evaluated according to age groups (group 1≤ 10 years; Group 2>10 years). Data of 111 patients (males= 56) were evaluated [mean age 9.4±4.2 years (0.8-16.2)]. Complete remission was observed in none of our patients. Partial remission was observed in 67 patients (60.4 %), and partial remission was observed more frequently in children≤ 10 years of age (p=0.043). No correlation was identified between clinical and laboratory characteristics at the time of diagnosis and frequency of partial remission. The frequency of partial remission was higher in younger children during the period of observation. Additionally, clinical and laboratory characteristics at the time of diagnosis were not helpful in predicting the degree of remission in this study group.

Integration of Routine Parameters of Glycemic Variability in a Simple Screening Method for Partial Remission in Children with Type 1 Diabetes

“…Using the IDAA1C formula, we found a prevalence of remission of 71% with a mean PR duration of 8.9 months and a peak prevalence 3 months after onset, as described elsewhere [ 10 , 13 , 14 , 17 , 25 ] even with different PR definition [ 39 ]. Also in agreement with previous studies [ 9 , 10 , 27 , 40 , 41 ] were the findings that T1D onset in patients between 5–10 years and higher C-peptide levels at diagnosis were more frequent in remitters, that younger onset (<5 years) of T1D was associated with a lower rate of PR and that presence of DKA (pH < 7.3) at diagnosis was negatively correlated with PR. Also, while other studies [ 10 , 17 , 42 ] described a negative correlation between anti-islet antibodies and PR, we found no such correlation within our cohort, which may partly be explained by the retrospective design of our study.…”

“…Although several groups studied characteristics of PR in patients with T1D [ 9 , 13 , 23 , 24 ], since 2009, most common prediction studies relied on the IDAA1C formula, which is a valid predictor of PR and stimulated C-peptide values above 0.3 pmol/mL [ 13 ]. Despite being validated by different authors [ 10 , 14 , 15 , 25 ] and widely used [ 10 , 11 , 26 , 27 ], IDAAC1 has two main limitations. First, the correlation of IDAA1C with C-peptide loses specificity and sensitivity with age [ 13 , 14 , 17 ] and tends to underestimate C-peptide levels in children presenting a score above 9 [ 14 – 16 ].…”

Features of partial remission in children with type 1 diabetes using the insulin dose-adjusted A1c definition and risk factors associated with nonremission

“…In this study, the frequency of PR in our cohort was 45.6%. This number is comparable to that reported by other published studies that also defined PR using the IDAA1c criteria (range, 35%–71.1%) [ 16 - 21 ]. IDAA1c is an easy-to-use formula in a clinic setting that gives reasonable sensitivity and specificity in identifying PR status and guiding management planning.…”

“…This number is comparable to that reported by other published studies that also defined PR using the IDAA1c criteria (range, 35%-71.1%). [16][17][18][19][20][21] IDAA1c is an easy-to-use formula in a clinic setting that gives reasonable sensitivity and www.e-apem.org specificity in identifying PR status and guiding management planning. However, it has not yet been validated in patients using insulin pumps who often require lower TDDs relative to patients receiving multiple daily injections.…”