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Boutsen L, Costenoble E, Pollé O, Erdem K, Bugli C, Lysy PA. Influence of the occurrence and duration of partial remission on short-term metabolic control in type 1 diabetes: the DIABHONEY pediatric study. Ther Adv Endocrinol Metab 2023; 14:20420188221145550. [PMID: 36699944 PMCID: PMC9869204 DOI: 10.1177/20420188221145550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/26/2022] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the residual effect of partial remission (PR) on immediate post-PR glycemic control according to its occurrence and duration in a cohort of children with type 1 diabetes mellitus (T1DM). PATIENTS AND METHODS Values of glycemic control parameters [i.e. HbA1C, insulin dose-adjusted hemoglobin A1C (IDAA1C), glycemic target-adjusted HbA1C (GTAA1C)] and data from glucose monitoring devices from 189 pediatric patients with new-onset type 1 diabetes were collected retrospectively from 24 months. Patients were characterized according to their remission status (PR+ and PR-). PR+ patients were subdivided into three subgroups regarding PR duration [i.e. short (⩾3-⩽6 months), intermediate (>6-⩽12 months), and long PR (>12-⩽14 months)]. We compared glycemic control data from each PR+ subgroup at +6 and +12 months post-PR with PR- patients at the same postdiagnosis time. Second, PR+ subgroups were compared with each other. RESULTS PR+ patients showed improved glycemic control (i.e. HbA1C, IDAA1C, and GTAA1C) at + 6 months post-PR when compared with nonremitters (PR-), independently of the PR duration subgroups (p < 0.05). Interestingly, patients in long PR+ subgroup exhibited higher positive residual effect than short PR+ subgroup with lower GTAA1C scores (p = 0.02), better time in range (TIR) (p = 0.003), less time in hypoglycemia (10.45 versus 16.13%, p = 0.03) and less glycemic variability (83.1 mg/dl versus 98.84 mg/dl, p = 0.03). No significant differences were found for glucose control between PR+ and PR- patients at +12 months post-PR. CONCLUSION This study supports the positive impact of PR occurrence and duration on short-term metabolic control (better HbA1C levels, IDAA1C and GTAA1C scores, TIR, and less glycemic variability) with the residual effect increasing according to PR duration.
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Affiliation(s)
| | | | | | - Kezban Erdem
- Pediatric Endocrinology Unit, Cliniques universitaires Saint Luc, Bruxelles, Belgium
| | - Céline Bugli
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
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Kaas A, Pfleger C, Kharagjitsingh AV, Schloot NC, Hansen L, Buschard K, Koeleman BPC, Roep BO, Mortensen HB, Alizadeh BZ. Association between age, IL-10, IFNγ, stimulated C-peptide and disease progression in children with newly diagnosed Type 1 diabetes. Diabet Med 2012; 29:734-41. [PMID: 22150609 DOI: 10.1111/j.1464-5491.2011.03544.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS The relation of disease progression and age, serum interleukin 10 (IL-10) and interferon gamma (IFNγ) and their genetic correlates were studied in paediatric patients with newly diagnosed Type 1 diabetes. METHODS Two hundred and twenty-seven patients from the Hvidoere Study Group were classified in four different progression groups as assessed by change in stimulated C-peptide from 1 to 6 months. CA repeat variants of the IL-10 and IFNγ gene were genotyped and serum levels of IL-10 and IFNγ were measured at 1, 6 and 12 months. RESULTS IL-10 decreased (P < 0.001) by 7.7% (1 month), 10.4% (6 months) and 8.6% (12 months) per year increase in age of child, while a twofold higher C-peptide concentration at 1 month (p = 0.06), 6 months (P = 0.0003) and 12 months (P = 0.02) was associated with 9.7%, 18.6% and 9.7% lower IL-10 levels, independent of each other. IL-10 concentrations did not associate with the disease progression groups. By contrast, IFNγ concentrations differed between the four progression groups at 6 and 12 months (P = 0.02 and P = 0.01, respectively); patients with rapid progressing disease had the highest levels at both time points. Distribution of IL-10 and IFNγ genotypes was equal among patients from the progression groups. CONCLUSION IL-10 serum levels associate inversely with age and C-peptide. As age and C-peptide also associate, a triangular association is proposed. Genetic influence on IL-10 production seems to be masked by distinct disease mechanisms. Increased serum IFNγ concentrations associate with rapid disease progression. Functional genetic variants do not associate with a single progression pattern group, implying that disease processes override genetically predisposed cytokine production.
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Affiliation(s)
- A Kaas
- Department of Paediatrics, Glostrup Hospital and University of Copenhagen, Denmark
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Arrieta-Blanco F, Botella-Carretero JI, Iglesias P, Balsa JA, Zamarrón I, De la Puerta C, Arrieta JJ, Ramos F, Vázquez C, Rovira A. Insulin action in adipose tissue in type 1 diabetes. Int J Gen Med 2011; 4:153-7. [PMID: 21475629 PMCID: PMC3068878 DOI: 10.2147/ijgm.s15809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Indexed: 01/21/2023] Open
Abstract
Background: Insulin action has been reported to be normal in type 1 diabetic patients. However, some studies have reported an insulin resistance state in these patients. The aim of this study was to investigate insulin resistance in a group of type 1 diabetic patients. We studied the insulin action in adipose tissue and analyzed the effects of duration of disease, body mass index (BMI), and glycosylated hemoglobin on insulin action at the receptor and postreceptor levels in adipocytes. Methods: Nine female type 1 diabetic patients with different durations of disease and eight nondiabetic female patients of comparable age and BMI were studied. 125I-insulin binding and U-[14C]-D-glucose transport was measured in a sample of subcutaneous gluteus adipose tissue obtained by open surgical biopsy from each subject. Results: The duration of disease was negatively correlated with both 125I-insulin binding capacity (r = −0.70, P < 0.05) and basal and maximum insulin-stimulated glucose transport (r = −0.87, P < 0.01, and r = −0.88, P < 0.01, respectively). Maximum specific 125I-insulin binding to the receptors in adipocytes was higher in the group of patients with a shorter duration of disease (P < 0.01). Basal and maximum insulin-stimulated glucose transport was significantly higher in the group with less than 5 years of disease (P < 0.01). No correlation was found between BMI and insulin action. Conclusion: Female type 1 diabetic patients have normal insulin action. There is a high glucose uptake in the early phase of the disease, although a longer duration of disease appears to be a contributing factor to a decrease in insulin action in these patients, and involving both receptor and postreceptor mechanisms.
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Affiliation(s)
- Francisco Arrieta-Blanco
- Unit of Clinical Nutrition and Dietetics, Department of Endocrinology and Nutrition, Hospital Ramóny, Cajal, Madrid, Spain, Irycis, Ciberobn
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Schloot NC, Hanifi-Moghaddam P, Aabenhus-Andersen N, Alizadeh BZ, Saha MT, Knip M, Devendra D, Wilkin T, Bonifacio E, Roep BO, Kolb H, Mandrup-Poulsen T. Association of immune mediators at diagnosis of Type 1 diabetes with later clinical remission. Diabet Med 2007; 24:512-20. [PMID: 17381505 DOI: 10.1111/j.1464-5491.2007.02096.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS We tested the hypothesis that systemic concentrations of cytokines, chemokines or soluble cytokine receptors predict or accompany clinical remission in Type 1 diabetes (T1D). METHODS In a prospective, multicentre study, 48 patients with newly diagnosed T1D and 55 age-matched healthy control subjects were investigated. Blood was drawn 3-7 days after the diagnosis and then 3-4 months later. Patients were grouped into partial remitters or non-remitters by the degree of clinical improvement defined by HbA(1c) (threshold 7.5%) and daily insulin dose (threshold 0.38 IU/kg/day). Systemic concentrations of 17 immune mediators were analysed in serum or plasma. In addition, autoantibodies against insulin (IAA), IA-2 (IA-2A) and GAD65 (GADA) were quantified. RESULTS All 17 immune mediators showed remarkable intra-individual stability in their systemic concentrations over time. As a consequence, partial remission was not accompanied by changes in mediator levels except for a moderate decrease of interleukin (IL)-1ra concentrations (P = 0.02) and IL-10 concentrations (P = 0.01) in non-remitters. Baseline levels were associated with the later clinical course in that low levels of interferon gamma (P = 0.01), IL-10 (P = 0.03) and IL-1R1 (P = 0.009) concentrations were observed in partial remitters. CONCLUSIONS We conclude that the systemic immunoregulatory state at diagnosis of T1D is predictive of clinical improvement during the remission phase. There was no general change in systemic immune reactivity in the months after diagnosis and initiation of insulin therapy.
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Affiliation(s)
- N C Schloot
- German Diabetes Centre, Heinrich Heine University, Düsseldorf, Germany.
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Song F, Chen W, Jia W, Yao P, Nussler AK, Sun X, Liu L. A natural sweetener, Momordica grosvenori, attenuates the imbalance of cellular immune functions in alloxan-induced diabetic mice. Phytother Res 2007; 20:552-60. [PMID: 16619338 DOI: 10.1002/ptr.1903] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Momordica grosvenori (MG), a traditional medicinal herb in China used as a substitute sugar for obese and diabetic patients, exhibited an enhancement of immunity. Heme oxygenase-1 (HO-1) is among the acute phase proteins that play an important role in the inflammatory process and have antiinflammatory activities with their antioxidant properties. The hypothesis that MG could modulate an imbalance of the cellular immune system and prevent the progression of diabetes mellitus, via induction of HO-1 protein expression was investigated. Diabetes was induced in male Balb/c mice by intraperitoneal injection of alloxan (200 mg/kg). The mice were randomly assigned to non-diabetic and diabetic groups, and further subdivided according to their treatments: control (distilled water), low dose MG (150 mg/kg) and high dose MG (300 mg/kg), which were administered by gavage in 24 h cycles over a 30 day period. MG administration effectively regulated the immune imbalance in diabetic mice, principally by upregulating the CD4(+) T lymphocyte subsets, and remodeling the intracellular cytokine profiles (reducing the expression of pro-inflammatory Th1 cytokines towards a beneficial Th2 pattern), ascribed to its induction and upregulation of HO-1. In conclusion, MG exhibited antidiabetic effects and may be used as a new natural drug for the treatment of diabetes.
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Affiliation(s)
- Fangfang Song
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan 430030, P.R. China
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Larger E, Rakotoambinina B, Eddouks M, Timsit J, Boitard C, Assan R, Burcelin R, Robert JJ. Normal insulin sensitivity during the late preclinical stage of type 1 diabetes. Diabetes Care 2004; 27:1842-3. [PMID: 15220282 DOI: 10.2337/diacare.27.7.1842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Larsen MO, Gotfredsen CF, Wilken M, Carr RD, Pørksen N, Rolin B. Loss of beta-cell mass leads to a reduction of pulse mass with normal periodicity, regularity and entrainment of pulsatile insulin secretion in Göttingen minipigs. Diabetologia 2003; 46:195-202. [PMID: 12627318 DOI: 10.1007/s00125-002-1011-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2002] [Revised: 09/27/2002] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes is associated with impaired insulin action and secretion, including disturbed pulsatile release. Impaired pulsatility has been related to impaired insulin action, thus providing a possible link between release and action of insulin. Furthermore, progressive loss of beta-cell mass has been implicated in the pathogenesis of Type 2 diabetes. The aim of this study was to evaluate a possible link between loss of beta-cell mass and impaired pulsatile insulin secretion with special focus on glucose responsiveness of insulin secretion. METHODS The kinetic and dynamic profiles of insulin in Göttingen minipigs are favourable for studies on pulsatility and a model of diabetes with reduced beta-cell mass has recently been established. Pigs were studied before (n=14) and after (n=10) reduction of beta-cell mass by nicotinamide (67 mg/kg) and streptozotocin (125 mg/kg) from 17.7+/-4.7 (normal animals, n=5) to 6.1+/-2.0 mg/kg. Pulsatile insulin secretion was examined during basal (n=8 normal, n=6 beta-cell reduced) and glucose entrained (n=6 normal, n=4 beta-cell reduced) conditions. Insulin concentration time series were analysed by autocorrelation and spectral analyses for periodicities and regularity, and by deconvolution for pulse frequency, mass and amplitude. RESULTS Reduction of beta-cell mass and secondary hyperglycaemia resulted in correspondingly (r=0.7421, p=0.0275) reduced pulse mass (42% of normal during basal and 31% during entrained conditions) with normal periodicity (6.6+/-2.2 vs 5.8+/-2.4 min, p=0.50), regularity and entrainability of insulin secretion. CONCLUSION/INTERPRETATION Neither beta-cell loss, nor 2 weeks of slight hyperglycaemia, as seen in the beta-cell-reduced minipig, probably accounts for the disturbed insulin pulsatility observed in human Type 2 diabetes.
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Affiliation(s)
- M O Larsen
- Department of Pharmacological Research I, Pharmacology, Research and Development, Novo Allé 6A1.005, 2880 Bagsvaerd, Denmark.
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Greenbaum CJ. Type 1 diabetes intervention trials: what have we learned? A critical review of selected intervention trials. Clin Immunol 2002; 104:97-104. [PMID: 12165270 DOI: 10.1006/clim.2002.5234] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Developing therapies to stop or slow the immune destruction of islets has been a goal of investigators in type 1 diabetes for several decades. This review of clinical interventions in patients with type 1 diabetes indicates both negative and positive outcomes with a variety of different therapeutic agents. An underlying theme of this article is that differences in study design may impact the outcome more than the therapy being tested. Thus, each of these results need to be considered in the context of important variables in study design. To date, there is no clear answer as to what study design is best to determine if an agent is effective against the diabetes disease process; however, the Immunology of Diabetes Society has recently developed guidelines for the conduct of these trials to facilitate comparisons of therapies in the future.
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Affiliation(s)
- Carla J Greenbaum
- Diabetes Clinical Research, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA.
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Abstract
Insulin resistance plays a larger role in the type 1 diabetes disease process than is commonly recognized. The onset of type 1 diabetes is often heralded by an antecedent illness and/or the onset of puberty, both conditions associated with insulin resistance. In the face of a damaged beta-cell and thus reduced insulin secretion, this change is enough to manifest hyperglycemia. During the first year of clinical disease, considerable evidence suggests that the occurrence of clinical remission or 'honeymoon period' is due to a temporary resolution of the insulin-resistant state present at diagnosis. Intensive diabetes management is associated with both improved insulin sensitivity and beta-cell function. This indicates that the historical data on the changes in insulin secretion post-diagnosis may be inappropriate when designing current studies. The known physiological relationship between beta-cell function and insulin sensitivity complicates interpretation of insulin secretion data obtained as part of prevention or intervention trials. While it is recommended that at least a subset of subjects participating in these trials undergo formal measurements of insulin sensitivity to evaluate effects of therapy on this parameter independent of effects on the beta-cell, the sample size must be sufficient to determine an effect if present. Finally, one could speculate that it is possible that subsets of people with mild manifestations of the type 1 autoimmune disease process could benefit from treatments aimed at improving the insulin-resistant state.
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Affiliation(s)
- Carla J Greenbaum
- Diabetes Clinical Research, Benaroya Research Institute at Virginia Mason, Seattle, WA 98108, USA.
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Diabetic honeymoon: prolonged at a price? Lancet 1989; 1:1235-6. [PMID: 2566783 DOI: 10.1016/s0140-6736(89)92333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
The available evidence concerning the pathogenesis of type 2 diabetes mellitus suggests that although insulin antagonism is common to many patient groups (i.e., obese, older), overt NIDDM will only develop in a subset who may have a genetic susceptibility for inadequate beta-cell reserves. Since the role of a receptor defect in causing type 2 diabetes is doubtful, the insulin antagonism in these patients is due to a post-receptor defect.
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