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- Title
New Definition for the Partial Remission Period in Children and Adolescents With Type 1 Diabetes.
- Authors
Mortensen, Henrik B.; Hougaard, Philip; Swift, Peter; Hansen, Lars; Holl, Reinhard W.; Hoey, Hilary; Bjoerndalen, Hilde; de Beaufort, Carine; Chiarelli, Francesco; Danne, Thomas; Schoenle, Eugen J.; Åman, Jan
- Abstract
OBJECTIVE -- To find a simple definition of partial remission in type 1 diabetes that reflects both residual β-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS -- A total of 275 patients aged < 16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual β-cell function. RESULTS-- By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient -0.21, P < 0.001) and insulin dose (-0.94, P < 0.001) was shown. These results suggested the definition of an insulin dose-adjusted A1C (IDAA1C) as A1C (percent) + [4 X insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C ≥9 corresponding to a predicted stimulated C-peptide >300 pmol/l was used to define partial remission. The IDAA1C ≤9 had a significantly higher agreement (P < 0.001) with residual β-cell function than use of a definition of A1C ≤7.5%. Between 6 and 12 months after diagnosis, for IDAA1C ≥ 9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C ≥7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose ≥0.5 units x kg[sup -1] x 24 h[sup -1] 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months. CONCLUSIONS--A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual β-cell function and has better stability compared with the conventional definitions.
- Subjects
DISEASE remission; DIABETES in children; DIABETES in adolescence; INSULIN; C-peptide
- Publication
Diabetes Care, 2009, Vol 32, Issue 8, p1384
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc08-1987