J Pediatr Endocrinol Metab 2017; aop Aleksandra Pyziak a , Agnieszka Zmyslowska a , Katarzyna Bobeff, Beata Malachowska, Wojciech Fendler, Krystyna Wyka, Anna Baranowska-Jazwiecka, Malgorzata Szymanska, Agnieszka Szadkowska and Wojciech Mlynarski* Markers influencing the presence of partial clinical remission in patients with newly diagnosed type 1 diabetes https://doi.org/10.1515/jpem-2017-0100 Received March 6, 2017; accepted August 28, 2017 Abstract Background: The aim of the study was to compare the selected markers in children with and without partial clinical remission (CR) of newly diagnosed type 1 diabetes (T1D). Methods: The study group consisted of 186 patients (F/M; 87/99) at onset of T1D and 24 months of follow-up. Partial CR was defined as insulin requirement <0.5 IU/kg and gly- cated hemoglobin (HbA 1c ) <7%. Results: Partial CR was observed in 115/186 (61.83%) of patients. At diagnosis body mass index standard devia- tion (BMI SDS) was higher among remitters than in non-remitters (p = 0.0051) and remitters were younger (p = 0.0029). In the follow-up a higher triglyceride concen- tration in non-remitters compared to remitters (p = 0.0455) and a lower high density lipoprotein (HDL) cholesterol level (p = 0.0119) were noticed. Conclusions: Younger age and higher BMI at diagnosis of T1D can predispose to partial CR in children. In patients with CR of T1D after 2 years of follow-up a lipid profile improvement is observed. Keywords: BMI; clinical remission; lipids; type 1 diabetes. Introduction Autoimmunity leading to destruction of pancreatic β-cells in type 1 diabetes mellitus (T1D) begins years before the clinical diagnosis of diabetes [1, 2]. An intensification of the process increases before insulin therapy administra- tion due to reduced endogenous insulin secretion and deficient insulin action. Hyperglycemia is a factor affect- ing the activation of metabolic processes, the immune system and escalating oxidative stress [3]. Reduction of glucose toxicity by effective insulin therapy after diagno- sis may improve the insulin secretion and reduce the scale of β-cells destruction [4, 5]. The β-cells rest may result in partial clinical remission (CR). Partial CR, also known as the honeymoon phenom- enon, is characteristic for a newly diagnosed T1D and may start after a few days or weeks after administration of insulin therapy and continue over the next weeks and months [6]. During this period a requirement for exoge- nous insulin decreases with normal metabolic control of diabetes and the blood glucose level is often in the normal range, despite variations in diet and exercise [7]. Further- more, preserved partial insulin secretion is subsequently associated with a lower incidence of vascular complica- tions of T1D in patients who experienced remission [4]. The most up-to-date definition of partial CR was defined in the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2014. According to the Guidelines, a remis- sion phase is recognized by the insulin requirement <0.5 units/kg of body weight and glycated hemoglobin (HbA 1c ) below 7%. Another definition proposed in the ISPAD Guidelines suggests using an insulin dose adjusted HbA 1c value and defined as HbA 1c (%) + 4 × [insulin dose in units/kg/24 h] ≤9 [7]. An important role in the pathogenesis of the honey- moon period is attributed to body weight and insulin resist- ance (IR), meaning impaired tissue sensitivity to insulin [8]. For an objective assessment of IR in patients with T1D a euglycemic insulin clamp is performed [9]. This method a Aleksandra Pyziak and Agnieszka Zmyslowska contributed equally to this work. *Corresponding author: Wojciech Mlynarski, MD, PhD, Department of Paediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna Str. 36/50, 91-738, Lodz, Poland, Phone: +48 42 6177750, Fax: +48 42 6177798, E-mail: wojciech.mlynarski@umed.lodz.pl Aleksandra Pyziak, Agnieszka Zmyslowska, Katarzyna Bobeff, Krystyna Wyka, Anna Baranowska-Jazwiecka, Malgorzata Szymanska and Agnieszka Szadkowska: Department of Paediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Lodz, Poland. http://orcid.org/0000-0001-8781-4469 (A. Zmyslowska) Beata Malachowska and Wojciech Fendler: Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland Brought to you by | University of Gothenburg Authenticated Download Date | 10/11/17 10:15 PM