Postinitial Remission in Diabetic Children– An Analysis of 178 Cases

Abstract

We studied 178 diabetic children and adolescents diagnosed during the period 1962-79 to find out the occurrence and duration of the postinitial remission, factors favoring a remission and the prognostic value of the remission. A postinitial remission occurred in 113 children (64%) being complete in only three boys (2%). The duration ranged from one month to 4.8 years, the mean being 8.4 months. The boys had a remission more often and of longer duration than the girls. The duration of diabetes was longer in the children without remission. The children with remission had lower blood glucose, milder hyperketonemia and ketonuria, higher pH and PCO2 at onset than those without remission. Hemoglobin A1 (HbA1) during 1979 were lower in the children with a positive remission history. The children with a remission lasting more than one year had a subsequently higher glucosuria index, lower HbA1 and higher C-peptide when compared to those without remission or to those with a short remission. The remission frequency increased from 1962 to 1979. Male sex and mild metabolic derangement at onset favor a postinitial remission, which results in a persisting residual beta-cell function and better metabolic control beyond the remission.

Clinical manifestations and beta cell function in Swedish diabetic children have remained unchanged during the last 25 years

“…Comparison with other studies is complicated by different definitions and different age groups, as there seems to be a positive correlation between remission rate and age at onset [28,29]. Our prevalence of nearly 60% and median duration of 0.9 years is however in concordance with some other studies [30,31], while others show both higher [29,32,33] and lower [25] rates varying from 40 to 80%. Since we defined partial remission as a period with insulin dose <0.5 U/kg/day the lower prevalence for the latest cohort does not necessarily mean a real decrease.…”

“…As in other studies we found the highest C-peptide values after 3 months [25,34,35], after which there was a gradual decline. There was a positive correlation with age, also demonstrated in other studies [25,28,29,31,34,35]. Male gender showed in our population a weak negative association, also reported by some other studies [35,36], while other authors have reported the opposite [29].…”

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

“…There is no consensus for the definition of partial remission. Only insulin requirement was used in some studies [8,[19][20][21]. Threshold values used for insulin requirements showed variability (0.3-0.5 units/kg/day) [13,14,22,23].…”

Overnight metabolic profiles in very young insulin-dependent diabetic children

“…These problems include a long overnight period (19.00 h to 07.00 h), small insulin dosage, a higher sensitivity to insulin [14], lipodystrophic injection sites and frequent intercurrent infections. A fast decline in the endogenous insulin reserve is seen after the onset of the disease [9,11]. In insulin-dependent diabetic adults on conventional treatment early morning hyperglycaemia, the so-called "dawn phenomenon", contributes to poor glycaemic control.…”