Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: An ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis

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

“…5 Another study from the UK reported the PR proportion was about 30% in adult individuals. 6 Notably, Humphreys et al compared the frequency of PR in children and adults and found that adult individuals >20 years old were more likely to enter PR, which is inconsistent with our results. Possible reasons might include that we used C-peptide as the marker for beta cell function recovery and the definition of PR instead of HbA1c and insulin dosage; also, the ethic difference should not be ignored.…”

“…3,4 Data of PR focused on adults are limited-Schölin et al showed that 61% of 16-to 50-yearold T1D patients had PR. 5 Humphreys et al from the UK reported a proportion of 30% in adult patients, 6 and they used the criteria of "glycosylated hemoglobin A1c (HbA1C) <7 % and an insulin dosage of <0.4 U/kg/day" instead of C-peptide levels as the biomarker for recovery of beta cell function. Although T1D develops most often during childhood, it can occur at any age.…”

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2020

“…Children with type 1 diabetes typically present with the hallmark symptoms of polyuria/polydipsia, and approximately one-third present with diabetic ketoacidosis (DKA) (2). The onset of type 1 diabetes may be more variable in adults; they may not present with the classic symptoms seen in children and may experience temporary remission from the need for insulin (3)(4)(5). Occasionally, patients with type 2 diabetes may present with DKA (6), particularly ethnic minorities (7).…”

“…Others have modest fasting hyperglycemia that can rapidly change to severe hyperglycemia and/or DKA with infection or other stress. Adults may retain sufficient b-cell function to prevent DKA for many years; such individuals may have remission or decreased insulin needs for months or years and eventually become dependent on insulin for survival and are at risk for DKA (3)(4)(5)39,40). At this latter stage of the disease, there is little or no insulin secretion, as manifested by low or undetectable levels of plasma C-peptide.…”

Variance of concern

“…Remission after diagnosis is associated with male sex, absence of ketoacidosis with a lower HbA 1c at diagnosis and fewer symptoms leading up to the diagnosis. 9 However, Mørk et al report that remission is not just a phenomenon of beta cell function but additionally reflects insulin sensitivity, 10 an important finding that offers opportunities to intervene to increase the likelihood, magnitude and duration of remission. Immunotherapeutic strategies may, in time, delay or prevent the onset of type 1 diabetes 11 but it is possible that established therapies may bridge the gap, or act as effective adjuncts.…”