Personal experience with the origin and duration of spontaneous remission in adult type 1 diabetics

Czech version

Authors: M. Voborská; K. Vondra; V. Zamrazil
Authors‘ workplace: Endokrinologický ústav, Praha, ředitel doc. MUDr. Vojtěch Hainer, CSc.
Published in: Vnitř Lék 2005; 51(2): 183-189
Category: Original Contributions

Overview

Objective of the Research:
Purpose of the present study was to obtain personal experience related to the occurrence and duration of spontaneous remission (R) in recent adult type 1 diabetics.

Patients and Methods:
Analysis of retrospective data of 40 long-term monitored adult type 1 diabetics (diagnosed at the age of 25.3 ± 5.7 years; 21 men, 19 women) revealed many pieces of knowledge, some of them being absolutely novel and unpublished in the scientific literature yet.

Results:
Totally 60% of patients (i.e. 24 patients) developed remission, 17% exhibited complete remission and remaining 43% partial remission. Partial remission lasted in average 46 weeks (6–159 weeks), complete remission lasted in average 59 weeks (24–79 weeks). Remission development occurred on the average of 11 weeks (1–60 weeks) after diabetes manifestation. Partial remission started to develop usually in the 12^th week (in the 1^st – 60^th week), while partial remission started to develop on the average in the 9^th week (in the 2^nd – 25^th week). Remission developed more frequently in patients who within the period before diagnosis of diabetes complained less often of polyphagia (R 6% vs. NR 38%; p < 0.03), of non-specific complaint (R 64% vs NR 100%; p < 0.04) and who observed lower body weight loss (R 9.8 ± 6.5% vs NR 13.5 ± 4.1%; p < 0.009). With incoming remission was associated lower dose of insulin (UI/kg/day, R 0.55 ± 0.24 vs NR 0.76 ± 0.38; p < 0.05) and less pronounced disturbance of the body's balance: R vs. NR, pH 7.43 ± 0.029 vs. 7.33 ± 0.034; HCO₃ 25.04 ± 1.43 mmol/l vs 17.57 ± 4.09 mmol/l; base excess 1.08 ± 1.53 mmol/l vs –7.25 ± 4.21 mmol/l; p < 0.01 for all) at the time of diabetes manifestation. What has not been reported until now is the positive correlation between better conserved late-phase insulin secretion (increase of the C-peptide in the 30^th minute after glucagon stimulation) in the period of diabetes manifestation and the occurrence of the remission. The remission was associated with relatively favourable development of function of Langerhans islets: in patients with a remission 24 months after diagnosis of diabetes a decrease in C-peptide level was in average 33% comparing to a baseline value while in patients without remission the same value was in average 71% (p < 0.01). Among different autoimmune markers of current insulitis only anti-insulin antibodies were monitored. The occurrence of these antibodies at the moment of diabetes diagnosis was substantially identical in the group with remission and in the group without remission development.

Conclusion:
It was demonstrated, that the relationship of remission and simple personal history parameters is as much important as the relationship to the expensive laboratory examinations. These conclusions demonstrate the importance of carefully accomplished personal history which has also a prognostic significance in the case of remission.

Key words:
diabetes mellitus type 1 – remission – predictive factors

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