Factors predicting clinical remission in adult patients with type 1 diabetes

• Published in: Journal of internal medicine Vol. 245; no. 2; pp. 155 - 162
• Main Authors: Schölin, A., Berne, C., Schvarcz, E., Karlsson, F. A., Björk, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.02.1999; Blackwell Science; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; Biological and medical sciences; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; insulin therapy remission; Male; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; Middle Aged; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; sex‐characteristics; Time Factors; type 1 diabetes mellitus; Endocrinopathy; Human; Immunopathology; Prognosis; Pathophysiology; Autoimmune disease; Insulin; Chemotherapy; Treatment; Insulin dependent diabetes; Adult; Evolution; Remission; Predictive factor
• ISSN: 0954-6820; 1365-2796; 1365-2796
• DOI: 10.1046/j.1365-2796.1999.00426.x

Objectives. To describe the course of clinical remission in adult patients (16–50 years of age) with type 1 diabetes and to identify factors predictive of the occurrence and length of remission. Design. A retrospective cohort study. Subjects. Sixty‐two consecutive patients (43 men and 19 women) with new onset IDDM, 27 ± 8 years at diagnosis and treated with multiple insulin injections from the beginning. Setting. Department of Medicine, Uppsala University Hospital and Örebro Medical Centre, Sweden. Main outcome measures. Length and occurrence of remission (defined as maintenance of HbA1C <6.5% and an insulin dosage of <0.4 U kg−1 day−1 for a minimum of 1 month) in relation to nine biochemical and clinical factors at diagnosis. Results. Sixty‐one per cent of the patients entered remission. The duration of remission was longer in males than females (10 ± 12 vs. 2 ± 3 months; P < 0.01). Male gender, normal serum bicarbonate at onset and a short time of classic symptoms before onset were predictive markers (P < 0.01; P < 0.05 and P < 0.01, respectively) for longer duration of remission. Low serum bicarbonate levels at onset were associated with lower occurrence of remission. Blood glucose, body mass index (BMI), and age at diagnosis did not influence the occurrence or the duration of remission. Conclusions. In most adult patients with new onset of type 1 diabetes remission is induced when using multiple insulin injection therapy. Male patients seem particularly prone to remission, and the length and extent of β‐cell strain prior to diagnosis strongly influences its course.