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Parameters associated with residual insulin secretion during the first year of disease in children and adolescents with Type 1 diabetes mellitus

1998; Wiley; Volume: 15; Issue: 10 Linguagem: Inglês

10.1002/(sici)1096-9136(199810)15

1464-5491

Riccardo Bonfanti, Elena Bazzigaluppi, Giliola Calori, Miller Riva, Matteo Viscardi, E. Bognetti, Franco Meschi, Emanuele Bosi, G Chiumello, Ezio Bonifacio,

Pancreatic function and diabetes

Diabetic MedicineVolume 15, Issue 10 p. 844-850 Original Article Parameters associated with residual insulin secretion during the first year of disease in children and adolescents with Type 1 diabetes mellitus R. Bonfanti, Corresponding Author R. Bonfanti Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalyClinica Pediatrica III, Istituto Scientifico H San Raffaele, via Olgettina 60, I-20132 Milan, ItalySearch for more papers by this authorE. Bazzigaluppi, E. Bazzigaluppi Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorG. Calori, G. Calori Epidemiology Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorM.C. Riva, M.C. Riva Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorM. Viscardi, M. Viscardi Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bognetti, E. Bognetti Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorF. Meschi, F. Meschi Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bosi, E. Bosi Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorG. Chiumello, G. Chiumello Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bonifacio, E. Bonifacio Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this author R. Bonfanti, Corresponding Author R. Bonfanti Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalyClinica Pediatrica III, Istituto Scientifico H San Raffaele, via Olgettina 60, I-20132 Milan, ItalySearch for more papers by this authorE. Bazzigaluppi, E. Bazzigaluppi Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorG. Calori, G. Calori Epidemiology Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorM.C. Riva, M.C. Riva Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorM. Viscardi, M. Viscardi Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bognetti, E. Bognetti Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorF. Meschi, F. Meschi Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bosi, E. Bosi Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorG. Chiumello, G. Chiumello Department of Paediatrics, Endocrine Unit, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this authorE. Bonifacio, E. Bonifacio Department of Medicine, Scientific Institute H San Raffaele, University of Milan, ItalySearch for more papers by this author First published: 19 July 2004 https://doi.org/10.1002/(SICI)1096-9136(199810)15:10 3.0.CO;2-ACitations: 60AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Abstract Factors associated with residual insulin secretion and spontaneous remission in Type 1 diabetic patients are important in the evaluation of treatment aimed at modifying the natural history of Type 1 DM. We investigated the effect of parameters at onset on residual beta cell function in 215 Type 1 DM children and adolescents. Blood gas analysis, HLA, GAD and IA-2 antibodies before the start of insulin treatment were recorded for each patient. Residual C-peptide secretion was assessed by the glucagon test, and parameters of metabolic control (HbA1c and insulin dose U kg−1 day−1) were examined at disease onset and after 3, 6, and 12 months. Residual C-peptide secretion throughout the first year of disease was significantly reduced in patients with disease onset before age 5. Multiple regression analysis showed that low pH at onset showed a significant and independent association with reduced C-peptide at 3 months (p = 0.02) and that the detection of GAD antibodies had a significant independent association with decreased C-peptide secretion at 6 months of follow-up (p = 0.02). Insulin requirement was higher in the youngest patients group and in patients with GAD antibodies. Spontaneous insulin remission (HbA1c <6 % and insulin <0.3 U kg−1 day−1) occurred in 22/192 (11 %) patients at 3 months of follow-up, in 15/190 (8 %) patients at 6 months and in 8/169 (5 %) patient at 12 months. Remission was more prevalent in older patients (p = 0.01) and in patients without detectable GAD antibodies: (14/64 vs 8/128, p = 0.001). Sex, IA-2 antibodies and HLA DR were not independently associated with C-peptide secretion, insulin requirement or remission in the first year of Type 1 DM. This study confirms the association of young age, severe acidosis at disease onset, and GAD antibodies with decreased residual beta-cell function and spontaneous remission during the first year of insulin treatment. These factors should be considered in trials evaluating therapies to retain beta-cell function and induce remission at and after disease onset. © 1998 John Wiley & Sons, Ltd. Citing Literature Volume15, Issue10October 1998Pages 844-850 RelatedInformation