Normal weight promotes remission and low number of islet antibodies prolong the duration of remission in Type 1 diabetes

• Published in: Diabetic medicine 2004-05, Vol.21 (5), p.447-455
• Main Authors: Schölin, A., Törn, C., Nyström, L., Berne, C., Arnqvist, H., Blohmé, G., Bolinder, J., Eriksson, J. W., Kockum, I., Landin-Olsson, M., Östman, J., Karlsson, F. A., Sundkvist, G., Björk, E.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Autoantibodies - blood; Biological and medical sciences; BMI; Body Mass Index; Body Weight; Clinical Medicine; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 1 - pathology; Diabetes. Impaired glucose tolerance; Drug Administration Schedule; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Humans; Hypoglycemic Agents - administration & dosage; Insulin - administration & dosage; islet antibodies; Islets of Langerhans - immunology; Klinisk medicin; Logistic Models; Male; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Prospective Studies; remission; Remission Induction; Survival Analysis; Time Factors; Type 1 DM; Type 1 DM; young adults
• ISSN: 0742-3071; 1464-5491; 1464-5491
• DOI: 10.1111/j.1464-5491.2004.01175.x

Aim  To identify clinical, immunological and biochemical factors that predict remission, and its duration in a large cohort of young adults with Type 1 diabetes mellitus (DM). Methods  In Sweden, 362 patients (15–34 years), classified as Type 1 DM were included in a prospective, nation‐wide population‐based study. All patients were followed at local hospitals for examination of HbA1c and insulin dosage over a median period after diagnosis of 5 years. Duration of remission, defined as an insulin maintenance dose ≤ 0.3 U/kg/24 h and HbA1c within the normal range, was analysed in relation to characteristics at diagnosis. Results  Remissions were seen in 43% of the patients with a median duration of 8 months (range 1–73). Sixteen per cent had a remission with a duration > 12 months. Among patients with antibodies (ab+), bivariate analysis suggested that adult age, absence of low BMI, high plasma C‐peptide concentrations, lack of ketonuria or ketoacidosis at diagnosis and low insulin dose at discharge from hospital were associated with a high possibility of achieving remission. Multiple regression showed that normal weight (BMI of 20–24.9 kg/m2) was the only factor that remained significant for the possibility of entering remission. In survival analysis among ab+ remitters, a low number of islet antibodies, one or two instead of three or four, were associated with a long duration of remissions. Conclusion  In islet antibody‐positive Type 1 DM, normal body weight was the strongest factor for entering remission, whilst a low number of islet antibodies was of importance for the duration. Diabet. Med. (2004)