eISSN: 2083-8441
ISSN: 2081-237X
Pediatric Endocrinology Diabetes and Metabolism
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1/2019
vol. 25
 
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abstract:
Original paper

Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Marta Rydzewska, Monika Kulesza, Marta Olszewska, Milena Jamiołkowska, Włodzimierz Łuczyński, Barbara Głowińska-Olszewska, Artur Bossowski

Pediatr Endocrinol Diabetes Metab 2019; 25 (1): 6-16
Online publish date: 2019/05/23
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Introduction

Type 1 diabetes mellitus (T1DM) is characterised by selective and progressive autoimmune destruction of pancreatic beta cells in genetically susceptible individuals [1]. The first symptoms of T1DM usually occur several years after the destruction process has started [2, 3]. The end-stage condition is a lack of endogenous insulin production, resulting in elevated blood glucose levels. Hyperglycaemia is a factor affecting the activation of the immune system, metabolic processes, and escalating oxidative stress [4]. A few decades ago it was believed that total destruction of the beta cells, once started, is inevitable; a belief which was implied by the growing need for insulin [5]. Now we know that some  cells may remain and may still be functional, even after decades of the course of the disease [6, 7]. Effective insulin therapy reduces glucose toxicity and may affect partial recovery of surviving beta cells and increased endogenous insulin produc-tion [8, 9]. This may result in partial clinical remission (CR), also known as the honeymoon phenomenon. During the partial clinical remission period the exogenous insulin requirement decreases with proper metabolic control of diabetes and the blood glucose levels are frequently stable and within the normal range. Furthermore, residual endogenous insulin secretion in patients with T1DM is associated with improved long-term glycaemic control, reduced risk of severe hypoglycaemia [10], and reduced risk for chronic microvascular complications in patients who entered partial CR [11]. According to the International Society for Paediatrics and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2014, the partial remission phase is defined as an insulin requirement of < 0.5 units/kg of body weight per day and glycated haemoglobin (HbA1c) < 7%. Recently, insulin dose-adjusted HbA1c, defined as HbA1c (%) + 4 × (insulin dose in units/kg/24 h), has been proposed as a more specific measure of remission [12].
It is important to discover which patients are predisposed to retaining some degree of endocrine function of the pancreas for a long period of time, and if anything can be done to preserve it. Recent studies have shown that appropriate treatment and follow-up during the honeymoon have the potential to enable the prolongation of this period for years, or even to permanently stop the destruction of the remaining ß cells; hence, the renewal of interest on the subject....


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keywords:

clinical remission, diabetes type 1 onset, C-peptide, physical activity

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