The remission phase in adolescents and young adults with newly diagnosed type 1 diabetes mellitus: prevalence, predicting factors and glycemic control during follow-up

Yazidi, Meriem; Mahjoubi, Sana; Oueslati, Ibtissem; Chaker, Fatma; Chihaoui, Melika

doi:10.20945/2359-3997000000456

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Original Article • Arch. Endocrinol. Metab. 66 (2) • Mar-Apr 2022 • https://doi.org/10.20945/2359-3997000000456 copy

The remission phase in adolescents and young adults with newly diagnosed type 1 diabetes mellitus: prevalence, predicting factors and glycemic control during follow-up

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

There is little data about the remission phase in adolescents and young adults with newly diagnosed type 1 diabetes mellitus (T1D). The aims of this study were to determine the prevalence of remission and its predicting factors among adolescents and young adults with newly diagnosed T1D and to assess the association between remission and long-term glycemic control in this population.

Subjects and methods:

This is a longitudinal and retrospective study including 128 type 1 diabetic patients aged between 12 and 30 years at diabetes onset. Clinical, biological and therapeutic features were collected at diagnosis and for 5 years after diagnosis. Remission was defined by an HbA1c < 6.5% with a daily insulin dose < 0.5 IU/kg/day.

Results:

Twenty-three patients (18%) experienced a remission. The peak of remission prevalence was at 6 months after diabetes diagnosis. An insulin dose at discharge <0.8 IU/kg/day was independently associated with remission (p=0.03, adjusted OR [CI 95%] = 0.2 [0.1-0.9]). A low socioeconomic level was independently associated with non remission (p=0.02, adjusted OR [CI 95%] = 4.3 [1.3-14.3]). HbA1c was significantly lower during the first five years of follow-up in remitters. The daily insulin dose was significantly lower during the first four years of follow-up in remitters.

Conclusions:

Occurrence of remission in adolescents and young adults with newly diagnosed T1D is associated with better glycemic control and lower insulin requirements during the first 5 years of follow-up. A lower initial dose of insulin was associated with a higher percentage of remission.

Keywords
Type 1 diabetes; remission; HbA1c; adults; adolescents

	Univariate analysis				Multivariate analysis
	Remitters (n=23)	Non remitters (n=105)	p value	OR [CI 95%]	p value	Adjusted OR [CI 95%]
Age < 21 years (%)	43.5	52.4	0.43	0.7 [0.3-1.7]
Adolescents (%)	17.4	38.1	0.05	0.3 [0.1-1.0]	0.28	0.5 [0.1-1.7]
Male gender (%)	65.2	59.0	0.58	1.3 [0.5-3.3]
Low socioeconomic status (%)	13.6	47.6	0.03	0.2 [0.0-0.6]	0.03	0.2 [0.1-0.9]
Associated autoimmune disease (%)	10.0	4.0	0.26	2.6 [0.4-15.7]
Underweight subjects (%)	13.0	26.7	0.16	0.4 [0.1-1.5]	0.64	0.7 [0.2-3.0]
Ketoacidosis at diagnosis (%)	17.4	18.1	0.93	0.9 [0.3-3.1]
Initial blood glucose value < 3.7 g/l (%)	65.2	46.5	0.11	2.1 [0.8-5.5]	0.38	1.6 [0.5-4.7]
HbA1c value at diagnosis < 14.2% (%)	45.5	51.5	0.73	0.8 [0.2-3.1]
Insulin dose at discharge < 0.8 IU/Kg/day (%)	82.6	41.9	<0.001	6.6 [2.1-20.7]	0.02	4.3 [1.3-14.3]

	Remitters	Non remitters	p
HbA1c at 3 months (%)	6.5 ± 1.9	8.5 ± 2.5	0.02
Insulin dose at 3 months (IU/kg/day)	0.42 ± 0.2	0.82 ± 0.3	<0.001
HbA1c at 6 months (%)	5.8 ± 0.6	7.6 ± 2.6	<0.001
Insulin dose at 6 months (IU/kg/day)	0.35 ± 0.2	0.79 ± 0.3	<0.001
HbA1c at 1 year (%)	7.1 ± 1.6	8.7 ± 2.4	0.004
Insulin dose at 1 year (IU/kg/day)	0.37 ± 0.2	0.75 ± 0.3	<0.001
HbA1c at 2 years (%)	7.8 ± 1.8	9.7 ± 2.5	0.004
Insulin dose at 2 years (IU/kg/day)	0.48 ± 0.2	0.73 ± 0.3	0.003
HbA1c at 3 years (%)	8.2 ± 1.9	9.8 ± 2.4	0.032
Insulin dose at 3 years (IU/kg/day)	0.46 ± 0.1	0.78 ± 0.3	0.001
HbA1c at 4 years (%)	7.8 ± 1.8	10.1 ± 2.6	0.008
Insulin dose at 4 years (IU/kg/day)	0.55 ± 0.2	0.82 ± 0.2	0.001
HbA1c at 5 years (%)	8.3 ± 1.2	9.6 ± 2.5	0.018
Insulin dose at 5 years (IU/kg/day)	0.62 ± 0.2	0.78 ± 0.2	0.129

Study (Country)	Patients characteristics	Diagnostic criteria of remission	Remission prevalence
Schölin et al. 1999 (Sweden) ( ²2 Scholin A, Berne C, Schvarcz E, Karlsson FA, Bjork E. Factors predicting clinical remission in adult patients with type 1 diabetes. J Intern Med 1999;245(2):155-62. )	62 new-onset T1D patients aged between 16 and 50 years	HbA1c ≤ 6.5% and an insulin dose ≤ 0.4 IU/kg/day for at least one month	61%
Scholin et al. 2004 (Sweden) ( ⁶6 Scholin A, Torn C, Nystrom L, Berne C, Arnqvist H, Blohme G, et al. Normal weight promotes remission and low number of islet antibodies prolong the duration of remission in type 1 diabetes. Diabet Med. 2004;21(5):447-55. )	362 new-onset T1D patients aged between 15 and 35 years	HbA1c lower than the upper laboratory limit and an insulin dose < 0.3 IU/Kg/day	43%
Scholin et al. 2011 (Sweden) ( ⁷7 Schölin A, Nyström L, Arnqvist H, Bolinder J, Björk E, Berne C, et al.; Diabetes Incidence Study Group in Sweden (DISS). Proinsulin/C-peptide ratio, glucagon and remission in new-onset Type 1 diabetes mellitus in young adults. Diabet Med. 2011;28(2):156-61. )	78 new-onset T1D patients aged between 15 and 34 years	HbA1c within the normal range and an insulin dose < 0.3 IU/kg/day	45%
Pilacinski et al. 2012 Poland ( ⁸8 Pilacinski S, Adler AI, Zozulinska-Ziolkiewicz DA, Gawrecki A, Wierusz-Wysocka B. Smoking and other factors associated with short-term partial remission of type 1 diabetes in adults. Diabet Med. 2012;29(4):464-9. )	149 new-onset T1D patients aged between 16 and 35 years	HbA1c value <7.0% with an insulin dose <0.3 IU/kg/day and a random serum C-peptide concentration > 0.5 ng/mL	46%
Niedzwiecki et al. 2015 Poland ( ³3 Niedzwiecki P, Pilacinski S, Uruska A, Adamska A, Naskret D, Zozulinska-Ziolkiewicz D. Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes. J Diabetes Complications. 2015;29(8):1105-11. )	90 new-onset T1D patients aged between 18 and 35 years on functional insulin therapy	HbA1c < 6.5%, daily insulin requirement < 0.3 IU/kg/day and serum C peptide concentration >0.5 ng/mL	66%
Present study	128 new-onset T1D patients aged between 12 and 30 years	HbA1c < 6.5% and an insulin dose < 0.5 IU/kg/day	18.5%

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[1] Correspondence to: Meriem Yazidi. La Rabta Hospital, 1007 Tunis, Tunisia. E-mail: meriemyazidi@gmail.com