Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Possibilities of prolonging endogenous insulin production during the ”remission phase” of type 1 diabetes (T1DM) have been the focus of much interest in recent research.

The aim of the study
was to describe the course of clinical remission in children with new-onset type 1 diabetes and to compare the selected markers affecting the presence of partial clinical remission (CR), focusing, among others, on physical activity before/during diagnosis.

Material and methods
We recruited 82 children (aged 10 ±3.72 years) with T1DM. We gathered data regarding the course of the disease (two years of obser-vation), insulin treatment, and laboratory results. Endogenous insulin production was assessed on the basis of C-peptide fasting and prandial level. Remission of diabetes was defined according to actual criteria. Information about physical activity (PA) was obtained by telephone interview.

Results
Patients with no physical activity, in comparison with those with a high level of PA before the diagnosis, had significantly worse param-eters of acid-base balance at admission (p < 0.05). Patients with a higher PA level in the course of T1DM had significantly lower insulin requirements three months after diagnosis (p < 0.05). Patients < 10 years of age presented worse acid-base balance parameters (p < 0.05) at admission, lower fasting and postprandial C-peptide concentrations at admission (p < 0.05) and after two years of observation (p = 0.00), compared to the > 10-year-old group. In a follow-up lower insulin dose on the day of discharge and after 6 and 12 months, and higher postprandial C-peptide concentration was observed in patients with HbA1c below 11.3% (median) at admission compared to the group with HbA1c above 11.3%. Patients with remission at discharge from hospital presented fewer metabolic disturbances at ad-mission (p < 0.05) and lower insulin requirements from the date of discharge (p = 0.00) to the end of the first year (p < 0.05).

Conclusions
Lower insulin demand at discharge from hospital after diagnosis of T1DM in a child is connected with older age, lower HbA1c level, and better clinical condition at admission. Higher PA affects better biochemical parameters at diagnosis of T1DM and lower demand for insulin later. During the first two years of the disease clinical remission may be connected with higher physical activity, but longitudinal studies are still required.