Spontaneous complete remission of type 1 diabetes mellitus in an adult – review and case report

Abstract

Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results in low plasma insulin levels by destruction of beta cells of the pancreas. As part of the natural progression of this disease, some patients regain beta cell activity transiently. This period is often referred to as the ‘honeymoon period’ or remission of T1DM. During this period, patients manifest improved glycemic control with reduced or no use of insulin or anti-diabetic medications. The incidence rates of remission and duration of remission is extremely variable. Various factors seem to influence the remission rates and duration. These include but are not limited to C-peptide level, serum bicarbonate level at the time of diagnosis, duration of T1DM symptoms, haemoglobin A1C (HbA1C) levels at the time of diagnosis, sex, and age of the patient. Mechanism of remission is not clearly understood. Extensive research is ongoing in regard to the possible prevention and reversal of T1DM. However, most of the studies that showed positive results were small and uncontrolled. We present a 32-year-old newly diagnosed T1DM patient who presented with diabetic ketoacidosis (DKA) and HbA1C of 12.7%. She was on basal bolus insulin regimen for the first 4 months after diagnosis. Later, she stopped taking insulin and other anti-diabetic medications due to compliance and logistical issues. Eleven months after diagnosis, her HbA1C spontaneously improved to 5.6%. Currently (14 months after T1DM diagnosis), she is still in complete remission, not requiring insulin therapy.

Remission phase in children diagnosed with type 1 diabetes in years 2012 to 2013 in Silesia, Poland: An observational study

“…Based on these two values the presence and duration of PR were determined. PR was defined as a period with insulin requirements of less than 0.5 U/kg/day accompanied by hemoglobin A1c (HbA1c) level of less or equal to 7%; 53 mmol/mol (ISPAD Consensus Guidelines 2018) …”

“…In the vast majority of cases, the remission is partial. In very rare cases (0%‐3.2%) a complete remission, without requiring any insulin or oral anti‐diabetic medication, might occur . Reports are suggesting that total remission is more common among adults .…”

“…In very rare cases (0%‐3.2%) a complete remission, without requiring any insulin or oral anti‐diabetic medication, might occur . Reports are suggesting that total remission is more common among adults . Even though the PR period has been much more extensively studied in the paediatric population in comparison with adults, information regarding PR in patients with T1D diagnosed in adulthood is still limited.…”

An Ultra-Elderly Case of Acute-Onset Autoimmune Type 1 Diabetes Mellitus

“…The honeymoon period, which appears shortly after the onset of type 1 diabetes and persists for a few months to a few years, is sometimes experienced. During the honeymoon period, some patients regain beta cell activity transiently and the patient's insulin requirements are minimal and some patients are able to maintain normal or near normal blood glucose with reduced or no use of insulin [8]. Since she died after about 6 months from the onset and could not observe for a long period, it was not clear whether her stage was during the honeymoon period or her condition was SPIDDM.…”

Combined treatment with sitagliptin and vitamin D in a patient with latent autoimmune diabetes in adults

“…During, this period, which is frequently referred as a ‘honeymoon period’, patients present with improved glycemic control and their requirements in medication are diminishing. The incidence of remission in T1D almost always follows initial insulin treatment, is highly variable regarding the degree and the duration, and is more common in the adult population within the first year of diagnosis (5). In this case although insulin was never administered, a notable and fast improvement was evident soon after treatment initiation and was maintained for 2 years thereafter.…”