Influence of remission and its duration on development of early microvascular complications in young adults with type 1 diabetes

• Published in: Journal of diabetes and its complications Vol. 29; no. 8; pp. 1105 - 1111
• Main Authors: Niedzwiecki, Pawel, Pilacinski, Stanislaw, Uruska, Aleksandra, Adamska, Anna, Naskret, Dariusz, Zozulinska-Ziolkiewicz, Dorota
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2015; Elsevier Limited
• Subjects: Adult; Body mass index; Cholesterol; Chronic complications; Cohort Studies; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - physiopathology; Diabetes type 1; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - physiopathology; Diabetic Angiopathies - prevention & control; Disease Progression; Endocrinology & Metabolism; Female; Follow-Up Studies; Glycated Hemoglobin A - analysis; Humans; Hyperglycemia - prevention & control; Hypoglycemic Agents - therapeutic use; Incidence; Insulin; Insulin - therapeutic use; Insulin therapy; Male; Microangiopathy; Microvessels - drug effects; Microvessels - physiopathology; Poland - epidemiology; Prevalence; Prospective Studies; Remission; Remission Induction; Risk; Severity of Illness Index; Young Adult; Remission; Insulin therapy; Microangiopathy; Chronic complications; Diabetes type 1
• ISSN: 1056-8727; 1873-460X
• DOI: 10.1016/j.jdiacomp.2015.09.002

Abstract Introduction Prevalence of partial remission ranges between 20% and 80% in the initial course of type 1 diabetes. In this phase of the disease, a substantial insulin secretion contributes to good metabolic control. The aim of the study was to determine the association between presence of partial remission and occurrence of microangiopathy complications in type 1 diabetes. Material and Methods Ninety-eight consecutive patients with newly diagnosed type 1 diabetes were asked to participate in a cohort study. Partial remission was defined as the time in which all of the following criteria were met: HbA1c below 6.5% (48 mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5 ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7 years of follow-up, the occurrence of microangiopathy complications was analyzed. In statistical analysis, Mann–Whitney test, chi2 test and Fisher test were used for analysis between groups. We applied a Cox's multivariate regression model and univariate regression method. P < 0.05 was considered statistically significant. Results In univariate logistic regression, a significant association was found between absence of remission and occurrence of at least one microvascular complication. In the Cox proportional hazards regression model that included clinically significant parameters at diagnosis (presence of ketoacidosis, cigarette smoking and HbA1c value) as covariates, absence of remission was associated with occurrence of chronic complications of diabetes at 7 years [HR: 3.65 (95% CI 1.23–4.56), p = 0.04]. In non-remitters, higher incidence of at least one microvascular complication (46.4% vs. 7.6%), higher incidence of retinopathy (42.8% vs. 5.7%), and neuropathy (21.4% vs. 1.9%) was found. Conclusions Occurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.