Influence of the occurrence and duration of partial remission on short-term metabolic control in type 1 diabetes: the DIABHONEY pediatric study

Abstract

Objective: To evaluate the residual effect of partial remission (PR) on immediate post-PR glycemic control according to its occurrence and duration in a cohort of children with type 1 diabetes mellitus (T1DM). Patients and Methods: Values of glycemic control parameters [i.e. HbA 1C , insulin dose–adjusted hemoglobin A 1C (IDAA 1C ), glycemic target–adjusted HbA 1C (GTAA 1C )] and data from glucose monitoring devices from 189 pediatric patients with new-onset type 1 diabetes were collected retrospectively from 24 months. Patients were characterized according to their remission status (PR + and PR − ). PR + patients were subdivided into three subgroups regarding PR duration [i.e. short (⩾3–⩽6 months), intermediate (>6–⩽12 months), and long PR (>12–⩽14 months)]. We compared glycemic control data from each PR + subgroup at +6 and +12 months post-PR with PR − patients at the same postdiagnosis time. Second, PR + subgroups were compared with each other. Results: PR + patients showed improved glycemic control (i.e. HbA 1C , IDAA 1C , and GTAA 1C ) at + 6 months post-PR when compared with nonremitters (PR − ), independently of the PR duration subgroups (p < 0.05). Interestingly, patients in long PR + subgroup exhibited higher positive residual effect than short PR + subgroup with lower GTAA 1C scores (p = 0.02), better time in range (TIR) (p = 0.003), less time in hypoglycemia (10.45 versus 16.13%, p = 0.03) and less glycemic variability (83.1 mg/dl versus 98.84 mg/dl, p = 0.03). No significant differences were found for glucose control between PR + and PR − patients at +12 months post-PR. Conclusion: This study supports the positive impact of PR occurrence and duration on short-term metabolic control (better HbA 1C levels, IDAA 1C and GTAA 1C scores, TIR, and less glycemic variability) with the residual effect increasing according to PR duration.