Parameters associated with residual insulin secretion during the first year of disease in children and adolescents with Type 1 diabetes mellitus

R. Bonfanti, E. Bazzigaluppi, G. Calori, M. C. Riva, M. Viscardi, E. Bognetti, F. Meschi, E. Bosi, G. Chiumello, E. Bonifacio

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)844-850
Number of pages7
JournalDiabetic Medicine
Volume15
Issue number10
DOIs
Publication statusPublished - 1998

Keywords

  • Antibodies
  • C-peptide
  • Remission
  • Type 1 diabetes mellitus

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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