Seven years of remission in a type I diabetic patient.
OBJECTIVE
To analyze factors contributing to a long-term remission in a patient with type I diabetes.


METHODS
The patient was treated with cyclosporin for 16 mo after a short duration of symptoms. During the 7-yr follow-up, we tracked his glycemic control, oral glucose tolerance, insulin sensitivity, endogenous insulin secretion, and beta-cell immunology. The results are compared with those of matched diabetic patients and healthy control subjects.


RESULTS
Insulin therapy was discontinued after 5 wk. Thereafter the patient had normal fasting and home blood glucose concentrations and near-normal HbA1c without insulin therapy for 7 yr. During this period, he maintained islet cell antibodies, although his basal and glucagon-stimulated C-peptide concentrations were normal. He participated in active physical training and had an insulin sensitivity higher than in sedentary control subjects or trained diabetic patients and equal to that in healthy athletes. His oral glucose tolerance decreased gradually and became diabetic during the last 3 yr.


CONCLUSIONS
In this patient, an early start of cyclosporin therapy probably contributed to the maintenance of endogenous insulin secretion, and insulin sensitivity was high because of physical training. Consequently, the patient was able to maintain normoglycemia without exogenous insulin therapy for 7 yr.
Koivisto
V A
VA
Second Department of Medicine, University of Helsinki, Finland.
Leirisalo-Repo
M
M
Ebeling
P
P
Tuominen
J A
JA
Knip
M
M
Turunen
U
U
Mandrup-Poulsen
T
T
Pelkonen
R
R
D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D002096:C-Peptide / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology*; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000097:blood; D007515:Islets of Langerhans / Q000276:immunology; D008297:Male; D011384:Proinsulin / Q000097:blood; D012075:Remission, Spontaneous
D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D016572:Cyclosporine; D005947:Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D011384:Proinsulin; C024211:islet cell antibody