Division of Endocrinology, Department of Pediatrics; Department of Quantitative Health Sciences; Diabetes Division, Department of Medicine; UMass Metabolic Network
Endocrine System Diseases | Endocrinology, Diabetes, and Metabolism | Nutritional and Metabolic Diseases | Pediatrics
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.
new-onset type 1 diabetes, T1D, remission, children, adolescent
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Copyright: © 2017 Marino et al.
DOI of Published Version
Marino KR, Lundberg RL, Jasrotia A, Maranda LS, Thompson MJ, Barton BA, Alonso LC, Nwosu BU. A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes. PLoS One. 2017 May 1;12(5):e0176860. doi:10.1371/journal.pone.0176860. eCollection 2017. PubMed PMID: 28459844. Link to article on publisher's website
Link to article in PubMed. Data Availability: The study data files are publicly deposited in the University of Massachusetts Medical School’s institutional repository, eScholarship@UMMS, http://escholarship.umassmed.edu/pediatrics_data/5/. The permanent link to the data is https://doi.org/10.13028/M2G59M.
Marino, Katherine R.; Lundberg, Rachel L.; Jasrotia, Aastha; Maranda, Louise; Thompson, Michael J.; Barton, Bruce A.; Alonso, Laura C.; and Nwosu, Benjamin U., "A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes" (2017). Endocrinology/Diabetes. 61.
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