title: Factors contributing to partial remission in type 1 diabetes: analysis based on the insulin dose-adjusted HbA1c in 3657 children and adolescents from Germany and Austria.
abstract: OBJECTIVE
  Insulin dose-adjusted hemoglobin A1c (HbA1C, IDAA1c) correlates well with stimulated C-peptide levels, but has not yet been evaluated in a large cohort of patients with Type 1 diabetes (T1D).
  
  
  METHODS
  We investigated prevalence of partial remission (PREM) defined by IDAA1c ≤9 in 3657 in children with new-onset T1D who were continuously followed over 6 years. We evaluated the predictors of PREM using the multicenter database from the DPV (Diabetes Patienten Verlaufsdokumentation) registry.
  
  
  RESULTS
  PREM occurred in 71% of patients. Median duration was 9 (0-21) months. Compared to children <5 years at T1D onset, those aged 5-10 and ≥10 years had twice the chance of developing PREM (OR: 2.08, CI: 1.67-2.60; P < .001 and OR: 2.16, CI: 1.70-2.75; P < .001). Boys were more likely to develop PREM than girls (OR 1.41, CI: 1.18-1.69; P = .0002). Further predictors for PREM were: ketoacidosis, autoantibodies, and HbA1c at T1D onset. These results were confirmed by quantile regression analysis with duration of PREM as dependent variable.
  
  
  CONCLUSIONS
  This research on a large cohort provides insight into epidemiologic characteristics of PREM in T1D defined by IDAA1c. As IDAA1c does not discriminate between insulin sensitivity and secretion, available data cannot resolve whether the sex-difference in PREM reflects innate higher insulin resistance in girls, or better beta-cell recovery in boys. Further research is needed to clarify the usefulness and performance of IDAA1c in clinical practice.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria.
authors.forename: Katrin
authors.initials: K
authors.lastname: Nagl
authors.affiliation: Epidemiology and Medical Biometry, University of Ulm, Germany.|German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Hermann
authors.affiliation: Department of Pediatrics, University of Bonn, Germany.
authors.forename: Michaela
authors.initials: M
authors.lastname: Plamper
authors.affiliation: Department of Pediatrics, University of Greifswald, Germany.
authors.forename: Carmen
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Department of Pediatrics, University Hospital Jena, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Dost
authors.affiliation: Children's Hospital Auf der Bult, Hannover, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Kordonouri
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Austria.
authors.forename: Birgit
authors.initials: B
authors.lastname: Rami-Merhar
authors.affiliation: Epidemiology and Medical Biometry, University of Ulm, Germany.|German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D012042:Registries; D012074:Remission Induction; D012737:Sex Factors
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: adolescent; beta-cell function; child; diabetes mellitus, type 1; insulin resistance; insulin sensitivity; insulin-secreting cells; partial remission