Shorter Remission Period in Young Versus Older Children with Diabetes Mellitus Type 1

Abstract

Background: The initial period of diabetes type 1 is of great importance, since early metabolic adjustment has profound impact on long term control. The majority of pediatric centers in Germany participate in a national quality initiative, providing longitudinal data for central analysis.

Patients: 104543 anonymous data sets were obtained from 6123 pediatric patients under 18 years who were treated in 157 pediatric centers and monitored for 36 months at the same center starting from diagnosis.

Results: Partial remission (insulin <0.5 U/kg/d and HbA1c ≤7.0%) was present in 1992 children (32.5%) within the first 3 months after diagnosis. Remission phase lasted in average for 0.74±0.77 years and was significantly shorter in children below 10 years of age at onset of diabetes compared to the older patients. The remission period was significantly longer in boys, particularly in children under 10 years (p=0.0039). Multiple regression analysis showed a longer remission phase in children with pubertal diabetes onset. The children entering remission were younger, more often boys and had a lower initial HbA1c level.

Conclusion: These data from a large multicenter group of children with diabetes type 1 emphasize the influence of gender, pubertal stage and age at manifestation on the amount of insulin required, and therefore the clinical remission, during the first three years of the disease.

Key words

remission phase in type 1 diabetes - children - adolescents - puberty

References

• 1 Yki-Järvinen H, Koivisto VA. Natural course of insulin resistance in type 1 diabetes.  N Engl J Med. 1986;  315 225-229
• 2 Hramiak IM, Dupre J, Finegood DT. Determinants of clinical remission in recent-onset IDDM.  Diabetes Care. 1993;  16 125-132
• 3 Kordonouri O, Danne T, Enders I, Weber B. Does the long term clinical course of type 1 diabetes mellitus differ in patients with prepubertal and pubertal onset? Results of the Berlin Retinopathy Study.  Eur. J. Pediatr. 1998;  157 202-207
• 4 Örtqvist E, Falorni A, Scheynius A, Persson B, Lenmark A. Age governs gender-dependent islet cell autoreactivity and predicts the clinical course in childhood IDDM.  Acta Paediatr. 1997;  86 1166-1171
• 5 Komulainen J, Lounamaa R, Knip M, Kaprio EA, Akerblom HK. Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Childhood diabetes in Finland study group.  Arch Dis Child. 1996;  75 410-415
• 6 Schölin A, Berne C, Schvarcz E, Karlsson FA, Björk E. Factors predicting clinical remission in adult patients with type 1 diabetes.  J Int Med. 1999;  245 155-162
• 7 Holl RW, Grabert M, Schweiggert F, Heinze E. A computer program for prospective documentation of pediatric patients with type 1 diabetes mellitus.  Diabetes und Stoffwechsel. 1993;  3 232-238
• 8 Akerblom H. Definition of partial remission in insulin-dependent, juvenile-onset diabetes mellitus (IDDM).  Acta Paediatr Belg. 1980;  33 66
• 9 Kromeyer-Hauschild K, Wabitsch M, Kunze D, Geller F, Geiß HC, Hesse V. et al . Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben.  Monatsschrift für Kinderheilkunde. 2001;  8 807-818
• 10 Abdul-Rasoul M, Habib H, Al-Khouly M. The honeymoon phase in children with type 1 diabetes mellitus: frequency, duration, and influential factors.  Pediatric Diabetes. 2006;  7 101-107
• 11 Knip M, Säkkinen A, Huttunen NP, Käär ML, Länkelä S, Mustonen A, Akerblom H. Postinitial remission in diabetic children - an analysis of 178 cases.  Acta Paediatr Scand. 1982;  71 901-908
• 12 Drash AL. Clinical characteristics, presentation and initial clinical course. In: Clinical care of the diabetic child. Chicago: Year Book Medical Publishers 1987: 33-49
• 13 Arslanian SA, Heil BV, Becker DJ, Drash AL. Sexual dimorphism in insulin sensitivity in adolescents with insulin-dependent diabetes mellitus.  J Endocrinol Metab. 1991;  72 920-926
• 14 Danne T, Grüters A, Wladimora A, Weber B, Horn R, Mayr B, Brabant G. Gender specific differences of serum leptin in obese and normal-weight adolescents: studies in type 1 diabetes and Turner syndrome.  Horm Res. 1997;  48 103-107
• 15 Peveler RC, Fairbum CG, Boller I, Dunger D. Eating disorders in adolescents with IDDM: a controlled study.  Diabetes Care. 1992;  15 1356-1360
• 16 Pinkney JH, Bingley PJ, Sawtell PA. et al . The BartÂ’s-Oxford study group presentation and progress of childhood diabetes mellitus: a prospective population-based study.  Diabetologia. 1994;  37 70-74
• 17 Bober E, Dundar B, Buyukgebiz A. Partial remission phase and metabolic control in type 1 diabetes mellitus in children and adolescents.  J Pediatr Endocrinol Metab. 2001;  14 435-441
• 18 Kintzel K, Holl RW, Haberland H, Grabert M, Dost A. Die diabetische Ketoazidose (DKA) bei Erkrankungsbeginn im Kindes- und Jugendalter in der Bundesrepublik.  Diabetes und Stoffwechsel. 2003;  12 8-12
• 19 Klipper-Aurbach Y, Wassermann M, Braunspiegel-Weintrob N, Borstein D, Peleg S, Assa S. et al . Mathematical formulae for the prediction of the residual beta cell function during the first two years of disease in children and adolescents with insulin-dependent diabetes mellitus.  Med Hypotheses. 1995;  45 486-490
• 20 Pozzilli P, Manfrini S, Buzzetti R, Lampeter E, De Leeuw I, Iafusco D. et al . Glucose evaluation trial for remission (GETREM) in type 1 diabetes: a European multicenter study.  Diab Res Clin Pract. 2005;  68 258-264

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