UMMS Affiliation

Division of Endocrinology, Department of Pediatrics; Department of Quantitative Health Sciences; Diabetes Division, Department of Medicine; UMass Metabolic Network

Document Type

Data

File Format & Size

.xlsx (107 KB)

Publication Date

2-9-2017

Keywords

new-onset type 1 diabetes, T1D, remission, children, adolescent

Description

Manuscript abstract:

IMPORTANCE: >50% of patients with new-onset type 1 diabetes (T1D) do not enter partial clinical remission (PCR); early identification of these patients may improve initial glycemic control and reduce long-term complications.

AIM: To determine whether routinely obtainable clinical parameters predict non-remission in children and adolescents with new-onset T1D.

SUBJECTS AND METHODS: Data on remission were collected for the first 36 months of disease in 204 subjects of ages 2-14 years with new-onset type 1 diabetes. There were 86 remitters (age 9.1±3.0y; male 57%), and 118 non-remitters (age 7.0±3.1y; male 40.7%). PCR was defined as insulin-dose adjusted hemoglobin A1c of ≤9.

RESULTS: Non-remission occurred in 57.8% of subjects. Univariable analysis showed that the risk for non-remission was increased 9-fold in patients with 4 diabetes-associated auto-antibodies (OR = 9.90, p = 0.010); 5-fold in patients(odds ratio = 5.38, p = 0.032), 3-fold in those with bicarbonate of/dL at diagnosis (OR = 3.71, p = 0.008). Combined estimates of risk potential for HC03 and the number of autoantibodies by multivariable analysis, adjusted for BMI standard deviation score, showed HC03/dL with a clinically significant 10-fold risk (OR = 10.1, p = 0.074); and the number of autoantibodies with a 2-fold risk for non-remission (OR = 1.9, p = 0.105). Male sex and older age were associated with decreased risk for non-remission. A receiver-operating characteristic curve model depicting sensitivity by 1-specificity for non-remission as predicted by bicarbonate/dL, age3 diabetes-associated autoantibodies had an area under the curve of 0.73.

CONCLUSIONS: More than 50% of children and adolescents with new-onset T1D do not undergo partial clinical remission and are thus at an increased risk for long-term complications of diabetes mellitus. A predictive model comprising of bicarbonate/dL, age3 diabetes-associated autoantibodies has 73% power for correctly predicting non-remission in children and adolescents with new-onset T1D. Early identification of these non-remitters may guide the institution of targeted therapy to limit dysglycemia and reduce the prevalence of long-term deleterious complications.

Data Collection Start Date

1-1-2006

Data Collection End Date

9-30-2015

Methodology

Methodology is documented in manuscript.

Publisher

eScholarship@UMMS

Language

eng

Code Lists

The explanation for codes used in this dataset is available under "Additional Files."

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Nwosu-T1D-Remission-2017-02-09.csv (58 kB)
Dataset in csv format

Nwosu-T1D-Remission-2017-02-09-Codes.pdf (55 kB)
Nwosu T1D Remission Dataset Code List