title: Characteristics and determinants of partial remission in children with type 1 diabetes using the insulin-dose-adjusted A1C definition.
abstract: To evaluate the characteristics and determinants of partial remission (PR) in Belgian children with type 1 diabetes (T1D), we analyzed records of 242 children from our center. Clinical and biological features were collected at diagnosis and during follow-up. PR was defined using the insulin-dose-adjusted A1C definition. PR occurred in 56.2% of patients and lasted 9.2 months (0.5 to 56.6). 25.6% of patients entered T1D with DKA, which correlated with lower PR incidence (17.6% versus 82.3% when no DKA). In our population, lower A1C levels at diagnosis were associated with higher PR incidence and in young children (0-4 years) initial A1C levels negatively correlated with longer PR. Early A1C levels were predictive of PR duration since 34% of patients had long PRs (>1 year) when A1C levels were ≤ 6% after 3 months whereas incidence of long PR decreased with higher A1Cs. C-peptide levels were higher in patients entering PR and remained higher until 3 years after diagnosis. Initial antibody titers did not influence PR except for anti-IA2 titers that correlated with A1C levels after 2 years. Presence of 2 versus 1 anti-islet antibodies correlated with shorter PR. PR duration did not influence occurrence of severe hypoglycemia or diabetes-related complications but was associated with lower A1C levels after 18 months. We show that, at diagnosis of T1D, parameters associated with β-cell mass reserve (A1C, C-peptide, and DKA) correlate with the occurrence of PR, which affects post-PR A1C levels. Further research is needed to determine the long-term significance of PR.
authors.affiliation: Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Aurore
authors.identifier: 0000-0002-9477-4466
authors.initials: A
authors.lastname: Pecheur
authors.affiliation: Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Barrea
authors.affiliation: Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vandooren
authors.affiliation: Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Véronique
authors.initials: V
authors.lastname: Beauloye
authors.affiliation: Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Annie
authors.initials: A
authors.lastname: Robert
authors.affiliation: Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lysy
mesh_terms: D000293:Adolescent; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000737:chemistry*; D006801:Humans; D007223:Infant; D007328:Insulin / Q000737:chemistry*; D008297:Male; D012074:Remission Induction; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin