Partial remission phase of diabetes in children younger than age 10 years

Abstract

There is renewed interest in the phase of partial remission in recently diagnosed diabetes because of the potential for pharmacological and immune intervention to preserve beta cell function. 95 children younger than 10 years were investigated to assess the influence of age, sex, diabetic ketoacidosis (DKA), admission at diagnosis, and ethnicity on the frequency of remission and insulin requirements during the first two years after diagnosis. Partial remission was defined as a requirement of insulin < 0.5 U/kg body weight/day. There was partial remission in 41 patients, with no differences for children aged 2-4 years and those aged 5-9 years. None of the five children aged < 2 years remitted. Forty five of 95 children were admitted to hospital at diagnosis, of whom 26 of 45 had DKA (blood pH < 7.25). In this number of children we were unable to show a statistical difference in the rate of remission with respect to DKA, admission to hospital at diagnosis, sex, or South Asian ethnic background. There were no differences in insulin requirements between the different groups by the end of two years and at that time seven of the children required insulin < 0.5 U/kg/day. The results suggest that even in preschool children there is potential for attempting to preserve beta cell function.

Type 1 Diabetes: Etiology, Immunology, and Therapeutic Strategies

“…2). The honeymoon phase appears to occur more frequently with increasing age at onset (2,298) and can often last 3-6 mo, but may continue for 2 years. In this period, insulin doses can be greatly reduced or even withdrawn completely (9,257).…”

Immunological mechanisms associated with long‐term remission of human type 1 diabetes

“…While partial and transient remission with a mean duration of 7 to 10 months is a common clinical finding [1][2][3]6,7], this is the longest complete remission reported in type 1 DM. The patient was positive for DQB1*0303,0501 and DRB1*0101,0901, representing HLA markers associated with neutral and moderate diabetes risk in Caucasian individuals, respectively [17].…”

Dynamic changes in CD4+ CD25+ high T cell apoptosis after the diagnosis of type 1 diabetes

“…The duration of the remission period is under the control of many factors that influence glycaemic control. Depending on age, pubertal status, insulin sensitivity and criteria for partial remission, up to 60% of patients with T1D might experience a partial remission [4,16,[18][19][20][21]. Furthermore, partial remission has been shown to be a heterogeneous phenomenon with inter-and intraindividual variation [22] and factors such as diabetes care intensity and early identification of hyperglycaemic symptoms prior to diagnosis influencing its course [20].…”