Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

Cimbek E. A., Bozkır A., Usta D., Beyhun N. E., Ökten A., Karagüzel G.

JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, vol.34, no.10, pp.1311-1317, 2021 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 34 Issue: 10
  • Publication Date: 2021
  • Doi Number: 10.1515/jpem-2021-0048
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, EMBASE, MEDLINE
  • Page Numbers: pp.1311-1317
  • Keywords: children, insulin dose-adjusted HbA1c, remission, type 1 diabetes, BETA-CELL FUNCTION, GLYCEMIC CONTROL, MELLITUS, DURATION, AGE, FREQUENCY, PHASE, DEFINITION, YOUNGER, PERIOD
  • Karadeniz Technical University Affiliated: Yes


Objectives: Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods: This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of <_9. Results: Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 +/- 0.12 vs. 7.23 +/- 0.15, p=0.003), higher C-peptide levels (0.45 +/- 0.31 ng/mL vs. 0.3 +/- 0.22, p=0.003), and they were significantly older (9.3 +/- 3.6 years vs. 7.3 +/- 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 +/- 0.14 vs. 0.4 +/- 0.17 U/kg/day, p=0.014). Conclusions: Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.