Prolonged honeymoon phase in an adolescent with diabetes and thyrotoxicosis provides support for the accelerator hypothesis
: A 14‐yr‐old female presented with diabetes and Graves’ disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3–0.4 units/kg/day). An assessment of her pancreatic beta‐cell reserve, determined by comparing HbA...
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| Published in | Pediatric diabetes Vol. 9; no. 4pt2; pp. 417 - 419 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.08.2008
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| Subjects | |
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| Abstract | : A 14‐yr‐old female presented with diabetes and Graves’ disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3–0.4 units/kg/day). An assessment of her pancreatic beta‐cell reserve, determined by comparing HbA1c and insulin dose, suggested that this was greater than other patients with type 1 diabetes in our service 18 months postdiagnosis (n = 185). We suspect that excess thyroid hormone led to an insulin‐resistant state and accelerated her presentation with hyperglycaemia. Insulin resistance fell once normal thyroid function was restored and helped to attenuate further beta‐cell destruction when beta‐cell mass was relatively well preserved. |
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| AbstractList | : A 14‐yr‐old female presented with diabetes and Graves’ disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3–0.4 units/kg/day). An assessment of her pancreatic beta‐cell reserve, determined by comparing HbA1c and insulin dose, suggested that this was greater than other patients with type 1 diabetes in our service 18 months postdiagnosis (n = 185). We suspect that excess thyroid hormone led to an insulin‐resistant state and accelerated her presentation with hyperglycaemia. Insulin resistance fell once normal thyroid function was restored and helped to attenuate further beta‐cell destruction when beta‐cell mass was relatively well preserved. A 14-yr-old female presented with diabetes and Graves' disease. Eighteen months later, she was euthyroid on carbimazole, and her haemoglobin A1c (HbA1c) was normal (5.2%) on a small insulin dose (0.3-0.4 units/kg/day). An assessment of her pancreatic beta-cell reserve, determined by comparing HbA1c and insulin dose, suggested that this was greater than other patients with type 1 diabetes in our service 18 months postdiagnosis (n = 185). We suspect that excess thyroid hormone led to an insulin-resistant state and accelerated her presentation with hyperglycaemia. Insulin resistance fell once normal thyroid function was restored and helped to attenuate further beta-cell destruction when beta-cell mass was relatively well preserved. |
| Author | Brown, Kathryn J Cheetham, Tim D Reid, Judith Abdullah, Nadeem Al‐Khalidi, Omer |
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| Cites_doi | 10.2337/diacare.26.10.2865 10.1210/jc.2005-0960 10.2337/diacare.26.3.843 10.1111/j.1464-5491.2004.01368.x 10.1007/s00125-005-0033-2 10.1210/jc.2006-1494 10.1136/adc.2003.027821 10.1210/jcem-57-3-563 10.1210/jc.2004-1108 10.1136/adc.73.1.25 10.1136/bmj.315.7110.713 10.2337/diacare.26.10.2871 10.2337/diacare.29.02.06.dc05-1339 10.1210/jc.2002-020492 10.1007/s001250100548 |
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| References | 1995; 73 2006; 91 1997; 315 2004; 89 2002; 87 2003; 26 2006; 29 2007; 92 1985; 248 2001; 44 2005; 48 2005; 22 1983; 57 Dimitriadis (10.1111/j.1399-5448.2008.00347.x-BIB9) 1985; 248 Libman (10.1111/j.1399-5448.2008.00347.x-BIB3) 2003; 26 Wang (10.1111/j.1399-5448.2008.00347.x-BIB15) 2007; 92 Kibirige (10.1111/j.1399-5448.2008.00347.x-BIB4) 2003; 26 Cole (10.1111/j.1399-5448.2008.00347.x-BIB10) 1995; 73 Vaidya (10.1111/j.1399-5448.2008.00347.x-BIB12) 2002; 87 Dimitriadis (10.1111/j.1399-5448.2008.00347.x-BIB8) 2006; 91 Mochizuki (10.1111/j.1399-5448.2008.00347.x-BIB13) 2003; 26 Betts (10.1111/j.1399-5448.2008.00347.x-BIB5) 2005; 22 Velaga (10.1111/j.1399-5448.2008.00347.x-BIB14) 2004; 89 Dabelea (10.1111/j.1399-5448.2008.00347.x-BIB7) 2006; 29 Knerr (10.1111/j.1399-5448.2008.00347.x-BIB6) 2005; 48 Romaldini (10.1111/j.1399-5448.2008.00347.x-BIB16) 1983; 57 Ehtisham (10.1111/j.1399-5448.2008.00347.x-BIB11) 2004; 89 Gardner (10.1111/j.1399-5448.2008.00347.x-BIB1) 1997; 315 Wilkin (10.1111/j.1399-5448.2008.00347.x-BIB2) 2001; 44 |
| References_xml | – volume: 44 start-page: 914 year: 2001 end-page: 922 article-title: The accelerator hypothesis: weight gain as the missing link between type 1 and type 2 diabetes publication-title: Diabetologia – volume: 89 start-page: 526 year: 2004 end-page: 529 article-title: British Society for Paediatric Endocrinology and Diabetes Clinical Trials Group. 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hyperthyroidism publication-title: J Clin Endocrinol Metab – volume: 26 start-page: 843 year: 2003 end-page: 884 article-title: Association of the CTLA‐4 gene 49 A/G polymorphism with type 1 diabetes and autoimmune thyroid disease in Japanese children publication-title: Diabetes Care – volume: 248 start-page: E593 year: 1985 end-page: E601 article-title: Effect of thyroid hormone excess on action, secretion, and metabolism of insulin in humans publication-title: Am J Physiol – volume: 22 start-page: 144 year: 2005 end-page: 151 article-title: Increasing body weight predicts the earlier onset of insulin‐dependent diabetes in childhood: testing the ‘accelerator hypothesis’(2) publication-title: Diabet Med – volume: 29 start-page: 290 year: 2006 end-page: 294 article-title: Testing the accelerator hypothesis: body size, B‐cell function, and age at onset of type 1 (autoimmune) diabetes publication-title: Diabetes Care – volume: 315 start-page: 713 year: 1997 end-page: 717 article-title: Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis publication-title: BMJ – volume: 91 start-page: 1112 year: 2006 end-page: 1118 article-title: Glucose and lipid fluxes in the adipose tissues after meal ingestion in hyperthyroidism publication-title: J Clin Endocrinol Metab – volume: 26 start-page: 2871 year: 2003 end-page: 2875 article-title: Changing prevalence of overweight children and adolescents at onset of insulin‐treated diabetes publication-title: Diabetes Care – volume: 26 start-page: 2865 year: 2003 end-page: 2870 article-title: Testing the accelerator hypothesis: the relationship between body mass and age at onset of type 1 diabetes publication-title: Diabetes Care – volume: 48 start-page: 2501 year: 2005 end-page: 2504 article-title: The ‘accelerator hypothesis’: relationship between weight, height, body mass index and age at diagnosis in a large cohort of 9248 German and Austrian children with type 1 diabetes mellitus publication-title: Diabetologia – volume: 26 start-page: 2865 year: 2003 ident: 10.1111/j.1399-5448.2008.00347.x-BIB4 article-title: Testing the accelerator hypothesis: the relationship between body mass and age at onset of type 1 diabetes publication-title: Diabetes Care doi: 10.2337/diacare.26.10.2865 contributor: fullname: Kibirige – volume: 91 start-page: 1112 year: 2006 ident: 10.1111/j.1399-5448.2008.00347.x-BIB8 article-title: Glucose and lipid fluxes in the adipose tissues after meal ingestion in hyperthyroidism publication-title: J Clin Endocrinol Metab doi: 10.1210/jc.2005-0960 contributor: fullname: Dimitriadis – volume: 26 start-page: 843 year: 2003 ident: 10.1111/j.1399-5448.2008.00347.x-BIB13 article-title: Association of the CTLA-4 gene 49 A/G polymorphism with type 1 diabetes and autoimmune thyroid disease in Japanese children publication-title: Diabetes Care doi: 10.2337/diacare.26.3.843 contributor: fullname: Mochizuki – volume: 22 start-page: 144 year: 2005 ident: 10.1111/j.1399-5448.2008.00347.x-BIB5 article-title: Increasing body weight predicts the earlier onset of insulin-dependent diabetes in childhood: testing the ‘accelerator hypothesis’(2) publication-title: Diabet Med doi: 10.1111/j.1464-5491.2004.01368.x contributor: fullname: Betts – volume: 48 start-page: 2501 year: 2005 ident: 10.1111/j.1399-5448.2008.00347.x-BIB6 article-title: The ‘accelerator hypothesis’: relationship between weight, height, body mass index and age at diagnosis in a large cohort of 9248 German and Austrian children with type 1 diabetes mellitus publication-title: Diabetologia doi: 10.1007/s00125-005-0033-2 contributor: fullname: Knerr – volume: 92 start-page: 88 year: 2007 ident: 10.1111/j.1399-5448.2008.00347.x-BIB15 article-title: Autoantibody negative diabetes is not rare at all ages and increases with older age and obesity publication-title: J Clin Endocrinol Metab doi: 10.1210/jc.2006-1494 contributor: fullname: Wang – volume: 89 start-page: 526 year: 2004 ident: 10.1111/j.1399-5448.2008.00347.x-BIB11 article-title: British Society for Paediatric Endocrinology and Diabetes Clinical Trials Group. First UK survey of paediatric type 2 diabetes and MODY publication-title: Arch Dis Child doi: 10.1136/adc.2003.027821 contributor: fullname: Ehtisham – volume: 57 start-page: 563 year: 1983 ident: 10.1111/j.1399-5448.2008.00347.x-BIB16 article-title: Comparison of effects of high and low dosage regimens of antithyroid drugs in the management of Graves hyperthyroidism publication-title: J Clin Endocrinol Metab doi: 10.1210/jcem-57-3-563 contributor: fullname: Romaldini – volume: 89 start-page: 5862 year: 2004 ident: 10.1111/j.1399-5448.2008.00347.x-BIB14 article-title: The codon 620 tryptophan allele of the lymphoid tyrosine phosphatase (LYP) gene is a major determinant of Graves’ disease publication-title: J Clin Endocrinol Metab doi: 10.1210/jc.2004-1108 contributor: fullname: Velaga – volume: 73 start-page: 25 year: 1995 ident: 10.1111/j.1399-5448.2008.00347.x-BIB10 article-title: Body mass index curves for the UK, 1990 publication-title: Arch Dis Child doi: 10.1136/adc.73.1.25 contributor: fullname: Cole – volume: 315 start-page: 713 year: 1997 ident: 10.1111/j.1399-5448.2008.00347.x-BIB1 article-title: Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis publication-title: BMJ doi: 10.1136/bmj.315.7110.713 contributor: fullname: Gardner – volume: 26 start-page: 2871 year: 2003 ident: 10.1111/j.1399-5448.2008.00347.x-BIB3 article-title: Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes publication-title: Diabetes Care doi: 10.2337/diacare.26.10.2871 contributor: fullname: Libman – volume: 29 start-page: 290 year: 2006 ident: 10.1111/j.1399-5448.2008.00347.x-BIB7 article-title: Testing the accelerator hypothesis: body size, B-cell function, and age at onset of type 1 (autoimmune) diabetes publication-title: Diabetes Care doi: 10.2337/diacare.29.02.06.dc05-1339 contributor: fullname: Dabelea – volume: 87 start-page: 5385 year: 2002 ident: 10.1111/j.1399-5448.2008.00347.x-BIB12 article-title: The genetics of autoimmune thyroid disease publication-title: J Clin Endocrinol Metab doi: 10.1210/jc.2002-020492 contributor: fullname: Vaidya – volume: 44 start-page: 914 year: 2001 ident: 10.1111/j.1399-5448.2008.00347.x-BIB2 article-title: The accelerator hypothesis: weight gain as the missing link between type 1 and type 2 diabetes publication-title: Diabetologia doi: 10.1007/s001250100548 contributor: fullname: Wilkin – volume: 248 start-page: E593 year: 1985 ident: 10.1111/j.1399-5448.2008.00347.x-BIB9 article-title: Effect of thyroid hormone excess on action, secretion, and metabolism of insulin in humans publication-title: Am J Physiol contributor: fullname: Dimitriadis |
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| SubjectTerms | accelerator hypothesis Adolescent Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - physiopathology Female Graves Disease - complications Graves Disease - physiopathology Graves’ disease honeymoon phase Humans insulin resistance thyrotoxicosis Thyrotoxicosis - complications Thyrotoxicosis - physiopathology |
| Title | Prolonged honeymoon phase in an adolescent with diabetes and thyrotoxicosis provides support for the accelerator hypothesis |
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