Reference : New definition for the partial remission period in children and adolescents with type...
Scientific journals : Article
Human health sciences : Multidisciplinary, general & others
New definition for the partial remission period in children and adolescents with type 1 diabetes
Mortensen, H. B. [Glostrup University Hospital, Department of Paediatrics, Glostrup, Denmark]
Hougaard, P. [Department of Statistics, University of Southern Denmark, Glostrop, Denmark]
Swift, P. [Leicester Royal Infirmary Children's Hospital, Leicester, United Kingdom]
Hansen, L. [Glostrup University Hospital, Department of Paediatrics, Glostrup, Denmark]
Holl, R. W. [University of Ulm, Ulm, Germany]
Hoey, H. [Trinity College, National Childrens Hospital, Dublin, Ireland]
Bjoerndalen, H. [Ulleval University Hospital, Department of Pediatrics, Oslo, Norway]
De Beaufort, Carine mailto [University of Luxembourg > Luxembourg Centre for Systems Biomedicine (LCSB) >]
Chiarelli, F. [Clinica Pediatrica Universita, Chieti, Italy]
Danne, T. [Department of Paediatrics, Kinderkrankenhaus Auf der Bult, Hannover, Germany]
Schoenle, E. J. [University Children's Hospital, Zurich, Switzerland]
Åman, J. [Regionsjukhuset I Örebro, Örebro, Sweden]
Diabetes Care
Yes (verified by ORBilu)
[en] C peptide ; Adolescent ; Aging ; Body Mass Index ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1 ; Drug Administration Schedule ; Follow-Up Studies ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents ; Infant ; Insulin ; Longitudinal Studies ; Multivariate Analysis ; Puberty ; Regression Analysis ; Remission, Spontaneous
[en] 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. © 2009 by the American Diabetes Association.

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