New Definition for the Partial Remission Period in Children and Adolescents With Type 1 Diabetes

doi:10.2337/dc08-1987

New Definition for the Partial Remission Period in Children and Adolescents With Type 1 Diabetes

Henrik B. Mortensen, MD, DRMEDSCI¹,
Philip Hougaard, DRSCI²,
Peter Swift, MD³,
Lars Hansen, MD, DRMEDSCI¹,
Reinhard W. Holl, MD, PHD⁴,
Hilary Hoey, MD, PHD⁵,
Hilde Bjoerndalen, MD⁶,
Carine de Beaufort, MD, PHD⁷,
Francesco Chiarelli, MD, PHD⁸,
Thomas Danne, MD, PHD⁹,
Eugen J. Schoenle, MD, PHD¹⁰ and
Jan Åman, MD, PHD¹¹ the Hvidoere Study Group on Childhood Diabetes*

¹Glostrup University Hospital, Department of Paediatrics, Glostrup, Denmark;
²Department of Statistics, University of Southern Denmark, Glostrop, Denmark;
³Leicester Royal Infirmary Children's Hospital, Leicester, U.K.;
⁴University of Ulm, Ulm, Germany;
⁵Trinity College, National Childrens Hospital, Dublin, Ireland;
⁶Ulleval University Hospital, Department of Pediatrics, Oslo, Norway;
⁷Clinique Pediatrique, Centre Hospitalier de Luxembourg, Luxembourg;
⁸Clinica Pediatrica Universita, Chieti, Italy;
⁹Department of Paediatrics, Kinderkrankenhaus auf der Bult, Hannover, Germany;
¹⁰University Children's Hospital, Zurich, Switzerland;
¹¹Regionsjukhuset i Örebro, Örebro, Sweden.

Corresponding author: Henrik B. Mortensen, hbmo{at}glo.regionh.dk.

Abstract

OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual β-cell function and efficacy of insulin treatment.

RESEARCH DESIGN AND METHODS A total of 275 patients aged <16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual β-cell function.

RESULTS By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient −0.21, P < 0.001) and insulin dose (−0.94, P < 0.001) was shown. These results suggested the definition of an insulin dose–adjusted A1C (IDAA1C) as A1C (percent) + [4 × insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C ≤9 corresponding to a predicted stimulated C-peptide >300 pmol/l was used to define partial remission. The IDAA1C ≤9 had a significantly higher agreement (P < 0.001) with residual β-cell function than use of a definition of A1C ≤7.5%. Between 6 and 12 months after diagnosis, for IDAA1C ≤9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C ≤7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose ≤0.5 units · kg⁻¹ · 24 h⁻¹ 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months.

CONCLUSIONS A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual β-cell function and has better stability compared with the conventional definitions.

Footnotes

↵*A complete list of contributing members of the Hvidoere Study Group on Childhood Diabetes can be found in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc08-1987/DC1.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- Received November 4, 2008.
- Accepted May 3, 2009.
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