title: One year remission of type 1 diabetes mellitus in a patient treated with sitagliptin.
abstract: Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by the autoimmune destruction of pancreatic β-cells. This paper describes the case of a 19-year-old male patient who presented with glutamic acid decarboxylase (GAD) antibody positive and diabetic ketoacidosis, which mandated intensive insulin treatment. Once the ketoacidosis was controlled, an oral dose of 100 mg of sitagliptin was administered once a day. Ketoacidosis was managed by insulin and insulin daily requirement began to dwindle after one month, until its complete withdrawal at 8 weeks, when partial remission was reached. The patient has now remained on sitagliptin treatment alone for a year, without requiring insulin. The benefit observed with this medication is possibly associated with its immunological effects. Inhibition of dipeptidyl peptidase 4 in animal models deregulates the Th1 immune response, increases secretion of Th2 cytokines, activates CD4+CD25+FoxP3+ regulatory T-cells, and prevents IL17 production.
  
  
  CONCLUSIONS
  The use of insulin-dose-adjusted HbA1c constitutes the best way to define partial remission in T1DM patients.The use of sitagliptin in T1DM patients could help to decrease daily requirement of insulin by delaying β-cell loss and improving endogenous insulin production.The determination of antibodies against insulin, islet cells, and GAD permits differentiation of T1DM patients from those with atypical or ketosis-prone diabetes.
authors.affiliation: Departamento de Ciencias Fisiológicas , Universidad de Oriente , Ciudad Bolívar , Venezuela ; Unidad de Endocrinología, Diabetes, Metabolismo y Nutrición , Anexo A. Centro Médico Orinoco , Avenida Siegart, Ciudad Bolívar, 8001 Venezuela.
authors.forename: Marcos M
authors.initials: MM
authors.lastname: Lima-Martínez
authors.affiliation: Departamento de Medicina , Hospital Vargas , Caracas , Venezuela.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Guerra-Alcalá
authors.affiliation: Centro Médico El Valle , Porlamar , Venezuela.
authors.forename: Miguel
authors.initials: M
authors.lastname: Contreras
authors.affiliation: Servicio de Genética Médica , Universidad de Oriente , Ciudad Bolívar , Venezuela.
authors.forename: José
authors.initials: J
authors.lastname: Nastasi
authors.affiliation: Children's Hospital Oakland Research Institute , Oakland, California , USA.
authors.forename: Janelle A
authors.initials: JA
authors.lastname: Noble
authors.affiliation: Departments of Paediatrics and Human Genetics , McGill University Health Centre , Montreal, Quebec , Canada.
authors.forename: Constantin
authors.initials: C
authors.lastname: Polychronakos