New Definition for the Partial Remission Period in Children and Adolescents with T1D
- Henrik B Mortensen, MD, Dr Med SCI (hbmo{at}glo.regionh.dk)1,
- Philip Hougaard, Dr SCI2,
- Peter Swift, MD3,
- Lars Hansen, MD, Dr Med SCI1,
- 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, PHD on behalf of the Hvidoere Study Group on Childhood Diabetes11
- 1 Glostrup University Hospital, Department of Paediatrics, Glostrup, Denmark
- 2 Department of Statistics, University of Southern Denmark, Denmark
- 3 Leicester Royal Infirmary Children's Hospital, Leicester, United Kingdom
- 4 University of Ulm, Germany
- 5 Trinity College, National Childrens Hospital, Dublin, Ireland
- 6 Ulleval University Hospital, Department of Pediatrics, Oslo, Norway
- 7 Clinique Pediatrique, Centre Hospitalier de Luxembourg
- 8 Clinica Pediatrica Universita, Chieti, Italy
- 9 Kinderkrankenhaus auf der Bult, Department of Paediatrics, Hannover, Germany
- 10 University Children's Hospital, Zurich, Switzerland
- 11 Regionsjukhuset i Örebro, Örebro, Sweden
Abstract
Objective- To find a simple definition of partial remission (PR) in T1D that reflects both residual beta-cell function and efficacy of insulin treatment.
Research Design and Methods- 275 patients <16 years were followed from onset of T1D. After 1, 6 and 12 months stimulated C-peptide during a challenge was used as a measure of residual beta-cell function.
Results- By multiple regression analysis a negative association between stimulated C-peptide and HbA1c (-0.21, regression coefficient, p<0.001) and insulin dose (-0.94, regression coefficient, p<0.001) was shown. These results suggested the definition of an insulin dose-adjusted HbA1c (IDAA1c) as: HbA1c (%) + [4 x insulin dose (U/Kg/24h)]. A calculated IDAA1c ≤ 9 corresponding to a predicted stimulated C-peptide > 300 pmol/l was used to define PR. The IDAA1c ≤ 9 had a significantly higher agreement (p <0.001) with residual beta-cell function than using a definition of HbA1c ≤ 7.5 %. Between 6 and 12 months after diagnosis, using IDAA1c ≤ 9 only 1 patient entered PR and 61 PR ended; using HbA1c ≤ 7.5 %, 15 entered PR and 53 ended; using a definition of insulin dose ≤ 0.5 U/kg/24h 5 entered and 66 ended and for stimulated C-peptide (>300 pmol/l) 9 entered PR and 49 ended.
Results- IDAA1c at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months.
Conclusions- A new definition of PR is proposed including both glycemic control and insulin dose. It reflects residual beta-cell function and has a better stability compared with the conventional definitions.
Footnotes
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- Received November 4, 2008.
- Accepted May 3, 2009.
- Copyright © American Diabetes Association
