Diabetes UK | October 2019 | Taking a Type 1 diabetes honeymoon
People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. This ‘remission’ is sometimes referred to as the honeymoon phase; with this in mind recent research conducted by experts at University College London wanted to identify why the partial recovery does not happen to everyone as this could inform a better understanding of glycaemic control.
The team at UCL used data from ADDRESS 2 a collection of information and blood samples from over 5,000 people newly diagnosed with Type 1 diabetes, funded by Diabetes UK – to look at the characteristics of those who did and didn’t experience a honeymoon.
They tracked participants for 12 months after their diagnosis and defined a honeymoon period as a daily insulin dose of 0.4 units per kg of body weight (which is less insulin than most people with Type 1 would typically take), with an HbA1c of less than 53 mmol/mol (7.0%).
They found that the honeymoon was most likely to occur three months after a Type 1 diagnosis, but can begin anywhere up to 12 months after.
Prevalence of remission increased at age 20 years and at 3 months after diagnosis.
In those aged less than 20 years remission was more likely in males with no ketoacidosis and few symptoms (Source: Diabetes UK)
Read Diabetes UK Taking a Type 1 diabetes honeymoon [press release]
Humphreys, A. et al | 2019 | Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: An ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis |Diabetes Research and Clinical Practice | Vol.155| https://doi.org/10.1016/j.diabres.2019.107789
People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. Identification of predictors of this ‘remission’ could inform a better understanding of glycaemic control.
Participants in the ADDRESS-2 study were included who had 1 or 2 assessments of remission status (coincident insulin dose and HbA1c measurement, with remission defined by ≤0.4 units insulin/kg-body-weight/day with HbA1c < 53 mmol/mol). Demographic and clinical presentation characteristics were compared according to remission status and predictors of remission were explored by logistic regression analysis.
1470 first and 469 second assessments of remission status were recorded within 12 months of diagnosis of T1D. Step increases in the probability of remission were identified at age-at-diagnosis 20 years and 3 months after diagnosis (both p under 0.001). Among those aged less than 20 years, remission was associated with male gender (p equal to 0.02), no ketoacidosis (p equal to 0.02) and fewer than 2 symptoms at presentation (p equal to 0.004). None of these characteristics predicted remission in those aged equal to over 20 years. In the subgroup with two assessments, transition to remission was independently associated with first remission assessment in months 1–2 post-diagnosis (p equal to 0.01), with age-at-diagnosis more than or equal to 20 years (p equal to 0.01) and, in those aged less than 20 years, with an early HbA1c of less than 57 mmol/mol. Adiposity, ethnicity, autoantibody status and other autoimmune disease were unrelated to remission.
For those diagnosed before 20 years of age, males, ketoacidosis-free, with fewer symptoms and low early HbA1c were more likely to experience remission, but remission was most likely in anyone aged more than or equal to 20 at diagnosis.
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