Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes

Passanisi, Stefano; Salzano, Giuseppina; Gasbarro, Albino; Brancati, Valentina Urzì; M, Mondio; Pajno, Giovanni Battista; Alibrandi, Angela; Lombardo, Fortunato

doi:10.3390/ijerph17134801

Cited by 24 publications

(25 citation statements)

References 41 publications

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“…In our bivariate analysis, only the lower insulin dose at T1D onset could predict remission. Although not significant, and according to previous data, we found that patients with higher BMI and older age at diagnosis are more prone to experience remission ( 69 ). In general, children experience remission to a higher extend than adults, and within the first group, the probability of remaining in remission is greater as the onset age increased ( 70 ).…”

Section: Discussionsupporting

confidence: 78%

Candidate Biomarkers for the Prediction and Monitoring of Partial Remission in Pediatric Type 1 Diabetes

et al. 2022

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The partial remission (PR) phase, a period experienced by most patients with type 1 diabetes (T1D) soon after diagnosis, is characterized by low insulin requirements and improved glycemic control. Given the great potential of this phase as a therapeutic window for immunotherapies because of its association with immunoregulatory mechanisms and β-cell protection, our objective was to find peripheral immunological biomarkers for its better characterization, monitoring, and prediction. The longitudinal follow-up of 17 pediatric patients with new-onset T1D over one year revealed that, during the PR phase, remitter patients show increased percentages of effector memory (EM) T lymphocytes, terminally differentiated EM T lymphocytes, and neutrophils in comparison to non-remitter patients. On the contrary, remitter patients showed lower percentages of naïve T lymphocytes, regulatory T cells (TREG), and dendritic cells (DCs). After a year of follow-up, these patients also presented increased levels of regulatory B cells and transitional T1 B lymphocytes. On the other hand, although none of the analyzed cytokines (IL-2, IL-6, TGF-β1, IL-17A, and IL-10) could distinguish or predict remission, IL-17A was increased at T1D diagnosis in comparison to control subjects, and remitter patients tended to maintain lower levels of this cytokine than non-remitters. Therefore, these potential monitoring immunological biomarkers of PR support that this stage is governed by both metabolic and immunological factors and suggest immunoregulatory attempts during this phase. Furthermore, since the percentage of TREG, monocytes, and DCs, and the total daily insulin dose at diagnosis were found to be predictors of the PR phase, we next created an index-based predictive model comprising those immune cell percentages that could potentially predict remission at T1D onset. Although our preliminary study needs further validation, these candidate biomarkers could be useful for the immunological characterization of the PR phase, the stratification of patients with better disease prognosis, and a more personalized therapeutic management.

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Section: Discussionsupporting

confidence: 78%

Candidate Biomarkers for the Prediction and Monitoring of Partial Remission in Pediatric Type 1 Diabetes

et al. 2022

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“…Those who were diagnosed at a younger age had a lower HbA1c at diagnosis but had higher HbA1c from 3 months post‐diagnosis to 10 months post‐diagnosis. In part, some of this can be associated with the increased rate of partial clinical remission in children diagnosed at an older age 21,22 . Children who were diagnosed at a younger age were more likely to use insulin pumps, which is consistent with previous studies 23–26 .…”

Section: Discussionsupporting

confidence: 85%

Hemoglobin A1c trajectories in the first 18 months after diabetes diagnosis in the SWEET diabetes registry

et al. 2021

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Aim A majority of youth with type 1 diabetes do not meet recommended hemoglobin A1c (HbA1c) targets. The SWEET diabetes registry is a multi‐national registry of youth with diabetes. We used data from this registry to identify characteristics associated with glycemic control. Methods Patients in the SWEET diabetes registry with at least one HbA1c value within 10 days of diagnosis and three follow up measurements in the first 18 months of diagnosis were included (~10% of the SWEET diabetes registry). Locally weighted scatterplot smoothing was used to generate curves of HbA1c. Wilcoxon, Kruskal–Wallis, or χ2‐tests were used to calculate differences between groups. Results The mean HbA1c of youth in the SWEET diabetes registry is highest at diagnosis and lowest between months 4 and 5 post‐diabetes diagnosis. HbA1c continues to increase steadily through the first 18 months of diagnosis. There are no differences in HbA1c trajectories based on sex or use of diabetes technology. Youth in North America/Australia/New Zealand had the highest HbA1c throughout the first 18 months of diagnosis. The trajectory of youth from countries with nationalized health insurance was lower than those countries without nationalized health insurance. Youth from countries with the highest gross domestic product (GDP) had the highest HbA1c throughout the first 18 months of diagnosis. Conclusions In this subset of patients, the trajectory of youth from countries with nationalized health insurance was lower than those countries without nationalized health insurance. High GDP and high use of technology did not seem to protect from a higher trajectory.

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“…However, this period is very important to determine future glycemic control and to set habits, beliefs as long as fears (2). Current data suggest that chronically high glucose levels may impair insulin synthesis/ secretion, beta cells survival and insulin sensitivity, therefore improving blood glucose (BG) control is the most important step for preserving pancreatic beta cells (3,4).…”

Section: Introductionmentioning

confidence: 99%

Early Initiation of Intermittently Scanned Continuous Glucose Monitoring in a Pediatric Population With Type 1 Diabetes: A Real World Study

Franceschi

Cauvin²,

Stefani³

et al. 2022

Front. Endocrinol.

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BackgroundUse of Continuous Glucose Monitoring (CGM) systems early in the course of diabetes has the potential to help glycemic management and to improve quality of life (QoL). No previous research has examined these outcomes in children-adolescents with type 1 diabetes (T1D) who use intermittently scanned CGM (isCGM) starting within the first month after diagnosis.AimTo evaluate the impact of isCGM early after T1D diagnosis, on metabolic control and QoL, comparing a group who started the use of the device within one month from the onset with another one who started at least one year later.Subjects and MethodsPatients who used isCGM within 1 month from T1D diagnosis were enrolled in group A; those who didn’t have the device during the first year were considered as control group (group B). HbA1c and total daily insulin were evaluated at 3 (T1), 6 (T2) and 12 (T3) months post-baseline (T0, diabetes onset), QoL after 1 year. In group A, isCGM glucose metrics were also recorded.Results85 patients were enrolled in group A and 67 patients in group B. In group A isCGM was well accepted during follow up: no patient dropped out; percentage of time with active sensor was in mean > 87%; number of scans/day remained stable. QoL was higher in group A than in group B both in children-adolescents (p<0.0001) and in parents (p 0.003). Group A presented lower HbA1c during the first year after diagnosis (p<0.001), and this data correlated with glucose management indicator (GMI), time in range (TIR) and mean glucose. The honeymoon period lasted more in group A than in B (p 0.028). Furthermore, the mean hypoglycemia duration decreased during follow-up (p 0.001) in group A.ConclusionsEarly use of isCGM, starting within the first month after diagnosis, improves metabolic control and QoL in pediatric patients with T1D.

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Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes

Cited by 24 publications

References 41 publications

Candidate Biomarkers for the Prediction and Monitoring of Partial Remission in Pediatric Type 1 Diabetes

Candidate Biomarkers for the Prediction and Monitoring of Partial Remission in Pediatric Type 1 Diabetes

Hemoglobin A1c trajectories in the first 18 months after diabetes diagnosis in the SWEET diabetes registry

Early Initiation of Intermittently Scanned Continuous Glucose Monitoring in a Pediatric Population With Type 1 Diabetes: A Real World Study

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