Partial clinical remission in type 1 diabetes: a comparison of the accuracy of total daily dose of insulin of <0.3 units/kg/day to the gold standard insulin-dose adjusted hemoglobin A1c of ≤9 for the detection of partial clinical remission

Abstract

Background: It is unclear whether the gold standard test for the detection of partial clinical remission (PCR) in new-onset type 1 diabetes (T1D), the insulin-dose adjusted Hemoglobin A1c (IDAA1c) of ≤9, is superior to a new tool, total daily dose of insulin (TDD) of <0.3 units/kg/day. The aim of the study was to test the superiority of IDAA1c over TDD of <0.3 units/kg/day for the detection of PCR.

Methods: A retrospective analysis of 204 subjects of ages 2-14 years, mean age 7.9±3.2 years, (male 7.8±3.4 years, [n=98]; female 7.9±3.0 years, [n=106], p=0.816) with new-onset T1D. Anthropometric and biochemical data were collected for the first 36 months of disease. PCR was defined by both IDAA1c≤9 and TDD<0.3 units/kg/day.

Results: There were 86 (42.2%) (age 9.1±3.0 years; male 57%) remitters by IDAA1c≤9 criterion, and 82 (40.2%) remitters (age 7.3±2.8 years) by TDD of <0.3 units/kg/day criterion (p=0.655). The duration of PCR was 10.0±6.1 months using TDD<0.3 units/kg/day, and 9.2±5.5 months using IDAA1c (p=0.379). Subjects in PCR as denoted by TDD<0.3 units/kg/day had 1.44 times increased probability of entering PCR than those denoted by IDAA1c of ≤9, after adjusting for BMI, bicarbonate, and HbA1c:(OR=1.44, 95% CI [1.03-2.00], p=0.033). Peak prevalence for PCR was at 6-12 months by either definition; more subjects were in PCR at 6 months by IDAA1c ≤9: 62/86 (72.1%) than by TDD<0.3 units/kg/day: 43/82 (52.4%), (p=0.011).

Conclusions: There were no significant differences in the number of remitters, duration of PCR, or the time of peak remission defined by IDAA1c of ≤9 or TDD of <0.3 units/kg/day.

Keywords: bicarbonate; children and adolescents; hemoglobin A1c; honeymoon period; insulin; type 1 diabetes.