Factors associated with residual insulin sescretion and spontaneous remission in Type 1 diabetic patient are important in the evaluation of treatment aimed at modifying the natural history of Type 1 DM. We investigated the effect of parameters at onset on residual beta cell function in 215 Type 1 DM children and adolescent. Blood gas analysis, HLA, GAD and IA-2 antibodies before the start of insulin treatment were recorded for each patient. Residual C-peptide secretion was assessed by the glucagon test, and parameters of metabolic control (HbA(1c) and insulin dose U kg -1 day -1) were examined at disease onset and after 3,6 and 12 months. Residual C- peptide secretion throughout the first year of disease was significantly reduced in patients with disease onset before age 5. Multiple regression analysis showed that low pH at onset showed a significant and independent association with reduced C-peptide at 3 months (p = 0.02) and that the detection of GAD antibodies had a significant independent association with decreased C-peptide secretion at 6 months of follow-up (p = 0.02). Insulin requirement was higher in the youngest patients group and in patients with GAD antibodies. Spontaneous insulin remission (HbA(1c) <6% and insulin <0.3 U kg -1 day -1) occurred in 22/192 (11%) patients at 3 months of follow- up, in 15/190 (8%) patients at 6 months and in 18/169 (5%) patient at 12 months. Remission was more prevalent in older patients (p = 0.01) and in patients without detectable GAD antibodies: (14/64 vs 8/128 p = 0.001). Sex , IA-2 antibodies and HLA DR were not independently associated with C-peptide secretion, insulin requirement or remission in the first year of Type 1 DM. This study confirms the association of young age, severe acidosis at disease onset, and GAD antibodies with decreased residual beta-cell function and spontaneous remission during the first year of insulin treatment. These factors should be considered in trials evaluating therapies to retain beta- cell function and induce remission at and after disease onset.
|Number of pages||7|
|Publication status||Published - 1998|
- Type 1 diabetes mellitus
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism