medwireNews: Insulin sensitivity may be associated with the likelihood of partial remission in children and adolescents newly diagnosed with type 1 diabetes, regardless of C-peptide levels and BMI, research suggests.
“These patients could be the target of personalised interventions like insulin sensitizers or exercise in order to improve metabolic outcome and potentially prolong the partial remission phase,” say Freja Mørk (Steno Diabetes Center Copenhagen, Denmark) and study co-authors.
The team studied 78 children and adolescents (68% boys), aged between 3.3 and 17.7 years, who had been diagnosed with type 1 diabetes within the preceding 3 months. These children were first seen an average of 2.5 months after diagnosis, and again around 6 and 12 months later, at which times 51%, 42%, and 26%, respectively, were in partial remission, defined as having dose-adjusted glycated hemoglobin below 9.0% (75 mmol/mol).
At these timepoints, a corresponding 85%, 42%, and 44% had stimulated C-peptide levels greater than 300 pmol/L.
Eighteen participants did not enter partial remission despite having high C-peptide levels, and these children had significantly lower insulin sensitivity than the other study participants. This reduced level was observed at the first visit and persisted for the second and third visits.
Across the whole cohort, BMI standard deviation score ranged from –0.23 to +0.32 at the first visit, but total body fat did not significantly differ between groups when defined by C-peptide level and whether partial remission was achieved. There were also no BMI differences at later visits, and no differences in age or duration of type 1 diabetes at any visit.
In line with previous research, the team found that having diabetic ketoacidosis at diabetes onset was associated with a lower rate of partial remission, but it was not associated with C-peptide or insulin sensitivity.
Writing in Diabetic Medicine, the researchers note that double diabetes (ie, type 1 diabetes with features of type 2 diabetes) “is a rising challenge.”
They suggest that “the findings in our paediatric cohort might be the early identification of the patients most at risk” for developing this condition.
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