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Kennedy EC, Hawkes CP. Approaches to Measuring Beta Cell Reserve and Defining Partial Clinical Remission in Paediatric Type 1 Diabetes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:186. [PMID: 38397298 PMCID: PMC10887271 DOI: 10.3390/children11020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
CONTEXT Type 1 diabetes (T1D) results from the autoimmune T-cell mediated destruction of pancreatic beta cells leading to insufficient insulin secretion. At the time of diagnosis of T1D, there is residual beta cell function that declines over the subsequent months to years. Recent interventions have been approved to preserve beta cell function in evolving T1D. OBJECTIVE The aim of this review is to summarise the approaches used to assess residual beta cell function in evolving T1D, and to highlight potential future directions. METHODS Studies including subjects aged 0 to 18 years were included in this review. The following search terms were used; "(type 1 diabetes) and (partial remission)" and "(type 1 diabetes) and (honeymoon)". References of included studies were reviewed to determine if additional relevant studies were eligible. RESULTS There are numerous approaches to quantifying beta cell reserve in evolving T1D. These include c-peptide measurement after a mixed meal or glucagon stimuli, fasting c-peptide, the urinary c-peptide/creatinine ratio, insulin dose-adjusted haemoglobin A1c, and other clinical models to estimate beta cell function. Other biomarkers may have a role, including the proinsulin/c-peptide ratio, cytokines, and microRNA. Studies using thresholds to determine if residual beta cell function is present often differ in values used to define remission. CONCLUSIONS As interventions are approved to preserve beta cell function, it will become increasingly necessary to quantify residual beta cell function in research and clinical contexts. In this report, we have highlighted the strengths and limitations of the current approaches.
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Affiliation(s)
- Elaine C Kennedy
- Department of Paediatrics and Child Health, University College Cork, T12 DC4A Cork, Ireland
- INFANT Research Centre, University College Cork, T12 DC4A Cork, Ireland
| | - Colin P Hawkes
- Department of Paediatrics and Child Health, University College Cork, T12 DC4A Cork, Ireland
- INFANT Research Centre, University College Cork, T12 DC4A Cork, Ireland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Emet DC, Karavar HN, Gozmen O, Agyar AA, Ünsal Y, Canturk M, Cengiz P, Vuralli D, Ozon ZA, Gonc EN. Early weight gain after diagnosis may have an impact on remission status in children with new-onset type 1 diabetes mellitus. J Diabetes 2023; 15:1011-1019. [PMID: 37572062 PMCID: PMC10755610 DOI: 10.1111/1753-0407.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/22/2023] [Accepted: 07/24/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Residual beta-cell function and improvement in insulin sensitivity by reversal of glucose toxicity are two phenomena thought to be related to partial remission (PR). Body fat mass is the major determinant of insulin sensitivity. The aim of this study is to investigate the relationship between the rate of body weight gain after diagnosis of type 1 diabetes mellitus (T1DM) and other clinical factors for the development and duration of PR. METHODS Children (2-16 years) with new-onset T1DM (n = 99) were grouped into remitters and non-remitters by using insulin dose-adjusted glycosylated hemoglobin (HbA1c) values. Laboratory and clinical data as well as daily insulin requirement per kilogram of body weight at diagnosis and each visit were recorded, and the duration of PR was determined. Changes in body mass index standard deviation score (BMI-SDS) were calculated by the auxological data collected every 6 months. RESULTS There were 47 remitters (47.5%) and 52 (52.5%) non-remitters. The mean increase in BMI-SDS at the first 6 months of diagnosis was higher in the non-remitters than in the remitters (p = 0.04). Duration of PR was negatively correlated with the change in BMI-SDS between 6 and 12 months after diagnosis. Male sex, younger age, prepubertal status, and lower HbA1c were predictors of remission, among which male sex had the highest chance by multivariate regression. CONCLUSIONS Early rapid weight gain after diagnosis of T1DM may play a role in the lack of remission and shorter duration of PR. Interventions to prevent early rapid weight gain can maintain the development and prolongation of remission.
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Affiliation(s)
- Dicle Canoruc Emet
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Hande Nur Karavar
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Onur Gozmen
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Arife Aslan Agyar
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Yağmur Ünsal
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Merve Canturk
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Pınar Cengiz
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Dogus Vuralli
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - Z. Alev Ozon
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
| | - E. Nazlı Gonc
- Department of Pediatrics, Division of EndocrinologyHacettepe UniversityAnkaraTurkey
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3
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Pinheiro MM, Pinheiro FMM, de Arruda MM, Beato GM, Verde GACL, Bianchini G, Casalenuovo PRM, Argolo AAA, de Souza LT, Pessoa FG, Hirose TS, Senra EF, Ricordi C, Fabbri A, Infante M, Diniz SN. Association between sitagliptin plus vitamin D3 (VIDPP-4i) use and clinical remission in patients with new-onset type 1 diabetes: a retrospective case-control study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000652. [PMID: 37249465 PMCID: PMC10665061 DOI: 10.20945/2359-3997000000652] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/15/2023] [Indexed: 05/31/2023]
Abstract
Objective The occurrence of partial remission (honeymoon phase) in type 1 diabetes (T1D) has been associated with a reduced risk of chronic microvascular complications of diabetes. We have published case reports showing that a combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3 (VIDPP-4i) can prolong the honeymoon phase in patients with new-onset T1D. In the present case-control study, we investigated the frequency of occurrence of clinical remission (CR) in patients with new-onset T1D after VIDPP-4i treatment. Subjects and methods In this case-control study, we collected data spanning 10 years from medical records of 46 patients (23 females) recently diagnosed with T1D. Overall, 27 participants with CR (insulin dose-adjusted glycated hemoglobin [IDAA1c] ≤ 9) at 12 or 24 months composed the case group, and 19 participants without CR served as the control group. Chi-square with Yates correction was used to analyze the association between VIDPP-4i use and CR, and odds ratio (OR) was used to determine the chance of CR due to VIDPP-4i treatment exposure. Results In all, 37 patients (80.4%) experienced CR at some time over 24 months. The mean CR duration was 13.15 ± 9.91 months. Treatment with VIDPP-4i was significantly associated with CR. At 24 months, the OR of CR after VIDPP-4i exposure was 9.0 (95% confidence interval [CI] 2.21-30.18, p = 0.0036). Additionally, 9 (33.6%) and 4 (14.8%) patients in the VIDPP-4i group experienced insulin-free CR at 12 and 24 months, respectively. Conclusion Therapy with VIDPP-4i was associated with a higher frequency and duration of the honeymoon phase. Randomized controlled trials are needed to confirm these findings.
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Affiliation(s)
- Marcelo Maia Pinheiro
- Univag Centro Universitário, Várzea Grande, MT, Brasil,
- Universidade Anhanguera, São Paulo, SP, Brasil
- Beta Cell Center Diabetes & Endocrinologia, Cuiabá, MT, Brasil
| | - Felipe Moura Maia Pinheiro
- Hospital das Clínicas, Faculdade de Medicina de São Paulo, Universidade de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | | | | | | | | | | | | | - Camillo Ricordi
- Diabetes Research Institute (DRI) and Cell Transplant Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Fabbri
- Diabetes Research Institute Federation (DRIF), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Marco Infante
- Diabetes Research Institute (DRI) and Cell Transplant Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Diabetes Research Institute Federation (DRIF), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Rome, Italy
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Podolakova K, Barak L, Jancova E, Tarnokova S, Podracka L, Dobiasova Z, Skopkova M, Gasperikova D, Stanik J. Complete remission in children and adolescents with type 1 diabetes mellitus-prevalence and factors. Sci Rep 2023; 13:6790. [PMID: 37100887 PMCID: PMC10133219 DOI: 10.1038/s41598-023-34037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/23/2023] [Indexed: 04/28/2023] Open
Abstract
Little is known about complete remission in Type 1 diabetes mellitus (T1D) with the discontinuance of insulin treatment for a period of time. In this retrospective study we analysed the frequency and factors of onset and duration of 1. remission and 2. complete remission in children and adolescents with T1D from the Children Diabetes Centre in Bratislava, Slovakia. A total of 529 individuals with T1D, aged < 19 years (8.5 ± 4.3 years) at diabetes onset were included in the study. Remission was defined by HbA1c < 7.0% (53 mmol/mol) and an insulin daily dose < 0.5 IU/kg (and 0 IU/kg for complete remission). Remission occurred in 210 (39.7%) participants, and 15 of them had complete remission (2.8% from all participants). We have identified a new independent factor of complete remission onset (higher C-peptide). Complete remitters had a longer duration of remission compared with other remitters and also differed in lower HbA1c levels. No association was seen with autoantibodies or genetic risk score for T1D. Thus, not only partial but also complete remission is influenced by factors pointing toward an early diagnosis of T1D, which is important for better patient outcome.
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Affiliation(s)
- Kristina Podolakova
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Lubomir Barak
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Emilia Jancova
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Simona Tarnokova
- Department of Laboratory Medicine, National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Ludmila Podracka
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Zuzana Dobiasova
- Department of Metabolic Disorders, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05, Bratislava, Slovakia
| | - Martina Skopkova
- Department of Metabolic Disorders, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05, Bratislava, Slovakia
| | - Daniela Gasperikova
- Department of Metabolic Disorders, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05, Bratislava, Slovakia
| | - Juraj Stanik
- Department of Pediatrics, Medical Faculty of Comenius University and National Institute for Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia.
- Department of Metabolic Disorders, Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Dubravska Cesta 9, 845 05, Bratislava, Slovakia.
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Viswanathan A, Wood JR, Hatipoglu BA. What Is a Honeymoon in Type 1, Can It Go into Remission? Endocrinol Metab Clin North Am 2023; 52:175-185. [PMID: 36754493 DOI: 10.1016/j.ecl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Type 1 diabetes is a chronic autoimmune disorder that results in destruction of insulin-producing cells in the pancreas. The autoimmune process is thought to be waxing and waning resulting in variable endogenous insulin secretion ability. An example of this is the honeymoon phase or partial remission phase of type 1 diabetes, during which optimal control of blood glucoses can be maintained with significantly reduced exogenous insulin, and occasionally exogenous insulin can be temporarily discontinued altogether. Understanding this phase is important because even fairly small amounts of endogenous insulin secretion is associated with reduced risk of severe hypoglycemia and microvascular complications.
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Affiliation(s)
- Anuradha Viswanathan
- Section for Pediatric Endocrinology, Cleveland Clinic Children's, 9500 Euclid Avenue, R Building- R-3, Cleveland, OH 44195, USA.
| | - Jamie R Wood
- University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Betul A Hatipoglu
- University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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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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7
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Pietrzak I, Michalak A, Seget S, Bednarska M, Beń‐Skowronek I, Bossowski A, Chobot A, Dżygało K, Głowińska‐Olszewska B, Górnicka M, Horodnicka‐Józwa A, Jakubek‐Kipa K, Jarosz‐Chobot P, Marcinkiewicz K, Mazur A, Myśliwiec M, Nazim J, Niechciał E, Noczyńska A, Rusak E, Seifert M, Skotarczyk‐Kowalska E, Skowronek A, Szypowska A, Wais P, Walczak M, Wołoszyn‐Durkiewicz A, Wysocka‐Mincewicz M, Zubkiewicz‐Kucharska A, Szadkowska A. Diabetic ketoacidosis incidence among children with new-onset type 1 diabetes in Poland and its association with COVID-19 outbreak-Two-year cross-sectional national observation by PolPeDiab Study Group. Pediatr Diabetes 2022; 23:944-955. [PMID: 35700323 PMCID: PMC9350002 DOI: 10.1111/pedi.13379] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/13/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There are several observations that the onset of coronavirus 19 (COVID-19) pandemic was associated with an increase in the incidence of diabetic ketoacidosis (DKA). However, due to heterogeneity in study designs and country-specific healthcare policies, more national-level evidence is needed to provide generalizable conclusions. OBJECTIVE To compare the rate of DKA in Polish children diagnosed with type 1 diabetes (T1D) between the first year of COVID-19 pandemic (15 March 2020 to 15 March 2021) and the preceding year (15 March 2019 to 15 March 2020). METHODS Reference centers in 13 regions (covering ~88% of Polish children) retrospectively reported all new-onset T1D cases in children from assessed periods, including DKA status at admission, administered procedures and outcomes. Secondly, we collected regions' demographic characteristics and the daily-reported number of COVID-19-related deaths in each region. RESULTS We recorded 3062 cases of new-onset T1D (53.3% boys, mean age 9.5 ± 4.3 years old) of which 1347 (44%) had DKA. Comparing pre- and post-COVID-19 period, we observed a significant increase in the rate of DKA (37.5%-49.4%, p < .0001). The fraction of moderate (+5.4%) and severe (+3.4%) DKA cases increased significantly (p = .0089), and more episodes required assisted ventilation (+2.1%, p = .0337). Two episodes of DKA during 2020/2021 period were fatal. By region, change in DKA frequency correlated with initial COVID-19 death toll (March/April 2020) (R = .6, p = .0287) and change in T1D incidence (R = .7, p = .0080). CONCLUSIONS The clinical picture of new-onset children T1D in Poland deteriorated over a 2-year period. The observed increase in the frequency of DKA and its severity were significantly associated with the overlapping timing of the COVID-19 epidemic.
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Affiliation(s)
- Iwona Pietrzak
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland
| | - Arkadiusz Michalak
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland,Department of Biostatistics and Translational MedicineMedical University of LodzLodzPoland
| | - Sebastian Seget
- Department of Children's DiabetologyMedical University of SilesiaKatowicePoland
| | - Maria Bednarska
- Department of PediatricsUniversity Clinical Hospital in OpoleOpolePoland
| | - Iwona Beń‐Skowronek
- Department of Pediatric Endocrinology and DiabetologyMedical University in LublinLublinPoland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetology with Cardiology UnitMedical University of BialystokBiałystokPoland
| | - Agata Chobot
- Department of PediatricsUniversity Clinical Hospital in OpoleOpolePoland,Department of Pediatrics, Institute of Medical SciencesUniversity of OpoleOpolePoland
| | | | - Barbara Głowińska‐Olszewska
- Department of Pediatrics, Endocrinology and Diabetology with Cardiology UnitMedical University of BialystokBiałystokPoland
| | - Martyna Górnicka
- Department of Endocrinology and DiabetologyChildren's Memorial Health InstituteWarsawPoland
| | - Anita Horodnicka‐Józwa
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | - Katarzyna Jakubek‐Kipa
- Department of Pediatrics, Pediatric Endocrinology and DiabetesMedical College University of RzeszówRzeszówPoland
| | | | - Katarzyna Marcinkiewicz
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and DiabetesMedical College University of RzeszówRzeszówPoland
| | - Małgorzata Myśliwiec
- Department of Pediatrics, Diabetology and EndocrinologyMedical University of GdanskGdańskPoland
| | - Joanna Nazim
- Department of Pediatric EndocrinologyJagiellonian University Medical College, Faculty of Medicine, Institute of PediatricsKrakówPoland
| | - Elżbieta Niechciał
- Department of Pediatric Diabetes, Auxology and ObesityPoznan University of Medical SciencesPoznanPoland
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and DiabetologyWroclaw Medical UniversityWroclawPoland
| | - Ewa Rusak
- Department of Children's DiabetologyMedical University of SilesiaKatowicePoland
| | - Monika Seifert
- Department of Pediatric Endocrinology and DiabetologyWroclaw Medical UniversityWroclawPoland
| | | | - Anna Skowronek
- Department of Pediatric Endocrinology and DiabetologyMedical University in LublinLublinPoland
| | | | - Paulina Wais
- Department of Pediatric Diabetes, Auxology and ObesityPoznan University of Medical SciencesPoznanPoland
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental AgePomeranian Medical University in SzczecinSzczecinPoland
| | | | | | | | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology and NephrologyMedical University of LodzLodzPoland
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Shi M, Ji X, Xie Y, Zhong T, Tang R, Fan L, Li X. Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:938059. [PMID: 35928900 PMCID: PMC9344919 DOI: 10.3389/fendo.2022.938059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To propose a new definition of partial remission (PR) for patients with type 1 diabetes (T1D) of all-ages using insulin dose and glycated albumin (GA), and find the optimal cut-off values for stimulated C-peptide to diagnose PR in different age-groups. RESEARCH DESIGN AND METHODS Patients with newly diagnosed T1D (n=301) were included. GA/insulin dose was used to diagnose PR, and insulin dose-adjusted glycated albumin (IDAGA) was proposed to facilitate clinical application. The optimal diagnostic levels of IDAGA and stimulated C-peptide were determined in different age-groups (≤ 12y, 12-18y and ≥ 18y). Furthermore, the diagnostic consistency between different PR definitions was studied. RESULTS GA≤ 23%/insulin dose ≤ 0.5u/kg/day was used to define PR, and IDAGA (GA (%) + 40 * insulin dose(u/kg/day)) ≤ 40 was feasible in all age-groups. Whereas, the optimal diagnostic level showed difference for stimulated C-peptide (265.5, 449.3 and 241.1 pmol/L for the ≤ 12y, 12-18y and ≥ 18y age-group, respectively). About 40% of patients met the PR definition by stimulated C-peptide but not GA/insulin dose or IDAGA, who showed dyslipidemia and higher insulin resistance. CONCLUSIONS A new definition of the PR phase is proposed using GA/insulin dose, and the calculated IDAGA≤ 40 applies to all age-groups. The stimulated C-peptide to diagnose PR is the highest in the 12-18y age-group, which reflects the effect of puberty on metabolism. For patients with insulin resistance, it is not recommended to use stimulated C-peptide alone to diagnose PR.
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9
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Chen Y, Xia Y, Xie Z, Zhong T, Tang R, Li X, Zhou Z. The Unfavorable Impact of DR9/DR9 Genotype on the Frequency and Quality of Partial Remission in Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e293-e302. [PMID: 34390338 DOI: 10.1210/clinem/dgab589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Partial remission (PR) is a specific stage in type 1 diabetes (T1D). Although human leukocyte antigen (HLA) class II loci are the strongest genetic determinants in T1D, the relationship between PR and HLA remains unclear. OBJECTIVE To investigate the association between PR status and HLA genotypes in patients with T1D. METHODS A total of 237 patients with T1D were included. PR was defined according to C-peptide ≥300 pmol/L. The frequency of PR and peak C-peptide levels during remission phase were compared according to HLA status. Clinical characteristics including age of onset and diabetes autoantibodies were collected. All analyses were duplicated when subjects were divided into childhood- and adult-onset T1D. RESULTS The median follow-up time was 24 months, 65.8% (156/237) of patients with T1D went into PR. DR9/DR9 carriers had a lower PR rate (44.2% vs 70.6%, P = .001) and were less likely to enter PR (OR = 0.218, 95% CI 0.098-0.487, P < .001) than the non-DR9/DR9 carriers, observed in both childhood- and adult-onset T1D. Besides, the peak C-peptide level during PR phase was also lower in DR9/DR9 carriers, and more notable in adult-onset T1D. When compared with non-DR9/DR9 carriers, T1D with DR9/DR9 genotype presented an older age of onset and a lower positivity of zinc transporter 8 antibody (ZnT8A), and the lower trend of ZnT8A was only found in adult-onset T1D (P = .049). CONCLUSION Patients with T1D carrying susceptible DR9/DR9 are less prone to undergo PR. Additionally, the recovery extent of β-cell function during the PR phase tends to be lower in adults carrying DR9/DR9, which might be associated with ZnT8A.
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Affiliation(s)
- Yan Chen
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ying Xia
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Zhiguo Xie
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Ting Zhong
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Rong Tang
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xia Li
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
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Cimbek EA, Bozkır A, Usta D, Beyhun NE, Ökten A, Karagüzel G. Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c. J Pediatr Endocrinol Metab 2021; 34:1311-1317. [PMID: 34271601 DOI: 10.1515/jpem-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/20/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. METHODS This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. RESULTS Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). CONCLUSIONS Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.
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Affiliation(s)
- Emine Ayça Cimbek
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Aydın Bozkır
- Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Deniz Usta
- Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nazım Ercüment Beyhun
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ayşenur Ökten
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gülay Karagüzel
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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11
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Yeşiltepe-Mutlu G, Çapacı M, Can E, Gökçe T, Bayrakçı G, Muradoğlu S, İncir S, Çakır EP, Hatun Ş. A comparison of glycemic parameters and their relationship with C-peptide and Proinsulin levels during partial remission and non-remission periods in children with type 1 diabetes mellitus - a cross-sectional study. BMC Endocr Disord 2021; 21:18. [PMID: 33485357 PMCID: PMC7825237 DOI: 10.1186/s12902-021-00681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The aim of this study was to evaluate glycemic parameters in children with T1D who are in the PRP using intermittently scanned continuous glucose monitoring systems (isCGMS) and to investigate any relationships between CP and PI levels. METHODS The study included 21 children who were in the PRP and 31 children who were not. A cross-sectional, non-randomized study was performed. Demographic, clinical data were collected and 2 week- isCGMS data were retrieved. RESULTS The Serum CP showed a positive correlation with time-in-range in the PRP (p:0.03), however PI showed no correlations with glycemic parameters in both periods. The Serum CP and PI levels and the PI:CP ratio were significantly higher in the PRP group than in the non-PRP group. In the non-PRP group, the PI level was below 0.1 pmol/L (which is the detectable limit) in only 2 of the 17 cases as compared with none in the PRP group. Similarly, only 2 of the 17 children in the non-PRP group had CP levels of less than 0.2 nmol / L, although both had detectable PI levels. Overall time-in-range (3. 9-1.0 mmol/L) was significantly high in the PRP group. In contrast, the mean sensor glucose levels, time spent in hyperglycemia, and coefficient of variation levels (32.2vs 40.5%) were significantly lower in the PRP group. CONCLUSIONS Although the mean glucose and time in range during the PRP was better than that in the non-PRP group, the glycemic variability during this period was not as low as expected. While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters. Further studies are needed to determine if PI might prove to be a useful parameter in clinical follow-up.
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Affiliation(s)
- Gül Yeşiltepe-Mutlu
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey.
- Koç University School of Medicine, Istanbul, Turkey.
| | - Merve Çapacı
- Koç University School of Medicine, Istanbul, Turkey
| | - Ecem Can
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey
| | - Tuğba Gökçe
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey
| | - Gizem Bayrakçı
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey
| | - Serra Muradoğlu
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey
| | - Said İncir
- Department of Biochemistry, Koç University Hospital, Istanbul, Turkey
| | - Esra Papatya Çakır
- Department of Pediatric Endocrinology, Bakirköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Şükrü Hatun
- Department of Pediatric Endocrinology and Diabetes, Koç University Hospital, Topkapı, Zeytinburnu, 34010, Istanbul, Turkey
- Koç University School of Medicine, Istanbul, Turkey
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12
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Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134801. [PMID: 32635304 PMCID: PMC7369868 DOI: 10.3390/ijerph17134801] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023]
Abstract
Partial clinical remission (PCR) is a transitory period characterized by the residual endogenous insulin secretion following type 1 diabetes (T1D) diagnosis and introducing the insulin therapy. Scientific interest in PCR has been recently increasing, as this phase could be crucial to preserve functional beta cells after T1D onset, also taking advantage of new therapeutic opportunities. The aim of this study was to assess the frequency, duration and associated factors of PCR in children newly diagnosed with T1D. Our cohort study included 167 pediatric patients aged 13.8 ± 4.1 years. The association of clinical and laboratory factors with the occurrence and duration of PCR was evaluated via logistic regression and multivariable generalized linear model, respectively. PCR occurred in 63.5% of the examined patients. Patients who achieved the remission phase were significantly older, and they had lower daily insulin requirement compared with non-remitters. PCR was positively associated to body mass index (OR = 1.11; p = 0.032), pH value (OR 49.02; p = 0.003) and c-peptide levels (OR 12.8; p = 0.002). The average duration of PCR was 13.4 months, and older age at diagnosis was the only predictor factor. Two years after diagnosis remitter patients had lower HbA1c and daily insulin requirement.
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