Complete remission in children and adolescents with type 1 diabetes mellitus-prevalence and factors

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.

Figure 1

Association of selected factors with the duration of complete remission in children and adolescents with T1D. Pearson’s correlation of the duration of complete remission in complete remitters with age at DM diagnosis (A), and HbA1c at the time of DM diagnosis (B). Dotted lines represent the 95% confidence intervals of the regression line calculated with the linear regression analysis. Duration of complete remission in complete remitters in the presence of corticosteroid treatment at the time of DM diagnosis (C). The error bars in (C) show the confidence intervals of the mean. Differences in (C) were calculated using the t-test.