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Type 1 Diabetes Remission

Predictive Tool For Children With Type 1 Diabetes Will Improve Care, Avoid Complications

Predictive Tool For Children With Type 1 Diabetes Will Improve Care, Avoid Complications

Benjamin U. Nwosu, MD, has developed a valuable new tool in the battle against type 1 diabetes, according to a study published May 1 by PLOS ONE. The tool enables clinicians to predict whether children with newly diagnosed type 1 diabetes will experience temporary, but beneficial, partial clinical remission during their early months in treatment. Patients who are unlikely to enter the so-called "honeymoon phase" can then be closely monitored and treated appropriately to help avoid long-term complications associated with non-remission. "Our paper is the first to come up with a predictive model for nonremission," said Dr. Nwosu, associate professor of pediatrics. "This presents the opportunity for clinicians to identify patients who are unlikely to remit, and then begin to ensure a normal or close to normal glucose profile in the first months of treatment of type 1 diabetes." The study integrated simple and easily accessible clinical markers of nonremission and validated them against the gold-standard definition of partial clinical remission, which is an insulin-dose adjusted hemoglobin A1c level of 9 or less. Recent research has established that this measure confirms that patients have entered the honeymoon phase, in which they are able to make some of their own insulin and their blood glucose levels are restored to at or near normal levels for a period lasting from three months to a year after treatment begins. Prior to this definitive measure, it had been incorrectly assumed that all patients with newly diagnosed type 1 diabetes experienced partial clinical remission. "Using this gold-standard definition, we found that 57 percent of our patients did not have a honeymoon phase," said Nwosu. "That means half the population of children and adolescents diagnosed with type Continue reading >>

Spontaneous Complete Remission Of Type 1 Diabetes Mellitus In An Adult – Review And Case Report

Spontaneous Complete Remission Of Type 1 Diabetes Mellitus In An Adult – Review And Case Report

Type 1 diabetes mellitus (T1DM) is an autoimmune condition that causes progressive destruction of beta cells of the pancreas. It is a cellular-mediated autoimmune process occurring in genetically predisposed individuals, with a possible component of environmental triggers (1). The initial presentation of T1DM occurs more commonly in childhood or adolescence compared to adult life (2, 3). Clinical manifestations usually occur several years after the destruction process has begun (4). In newly diagnosed T1DM patients, after the initiation of insulin therapy, many patients tend to notice a decrease in insulin requirements. This occurs as part of the natural progression of the disease due to the transient recovery of beta cell function and normalization of insulin sensitivity (5, 6). This transient period of improved beta cell function is often referred to as the ‘honeymoon period’ (7). Based on the insulin requirements, the honeymoon phase is categorized further into either partial remission or complete remission. Most of the patients that experience a honeymoon period do require some amount of insulin, although this might be drastically reduced compared to prior doses. This is referred to as partial remission. Complete remission refers to patients with well-controlled blood glucose levels without requiring any insulin or oral anti-diabetic medication. Complete remission is extremely rare compared to partial remission (8–11). Pathogenesis of this recovery is not clearly understood. Some hypotheses link this recovery to the possible involvement of IL-10-dependent T-cell regulatory pathways (8–11). Honeymoon period has been more extensively studied in the paediatric population, compared to the adult population, leading to limited information regarding honeymoon phase Continue reading >>

4 Published Cases Of True Remission In T1d

4 Published Cases Of True Remission In T1d

4 Published Cases of True Remission in T1D Member 13 y.o. son T1D in 2016 - My FBS avg 105 4 Published Cases of True Remission in T1D Hello Everyone, I am new to the group and glad to meet everyone. My 12 year old son was diagnosed with T1D one year ago here in Durham, NC and is taking 5 units of Lantus nightly and 1 unit of Novalog per 20 carbs. We hear rumors of T1D remission from time to time, but is there any evidence of actual true remissions published in peer reviewed medical journals? To find this out I did a search through the National Library of Medicine and to my surprise I found 3 cases. I'll describe these and give links to the medical journals. Patient Experiences Complete Remission after 5 Years The first patient was part of a study out of Lund University, Department of Endocrinology in Sweden. The young man was part of a group of 107 adults diagnosed with diabetes who were tested in follow-ups at 3, 5 and 12 years after the original diagnosis of diabetes. Contrary to the decline of others in the study, this person improved. At 3 years after diagnosis, his C-peptide levels were 0.55 nmol/l - at 5 years after diagnosis, he no longer had the GADA antibodies and C-peptide had increased to 1.09. After 12 years his C-Peptide levels were still in the normal range at 1.08 nmol/l. This study was published in the journal Diabetes which is the journal of the American Diabetes Association, Volume 51(6): pages 1754, June 2002. The reference to this one gentlemen who underwent remission is buried somewhat in the article but if you do a "find" on the page using his results of "1.08" it will bring up the paragraph discussing this young man. The full text to this can be seen at 3 Children out of 71 Stated to Experience Remission The next study was done out of Endocrine U Continue reading >>

Remission In Type 1 Diabetes - What's New?

Remission In Type 1 Diabetes - What's New?

A number of factors promote to the occurrence of remission. Böber et al. conducted a retrospective study performed on patients diagnosed with IDDM [13]. In conclusion, history of infection prior to presentation and DKA at diagnosis was associated with young age and were the most important factors negatively influencing the remission rate in newly diagnosed IDDM patients. Knip et al. demonstrated that the boys had a remission more often and of longer duration than the girls. The children with remission had lower blood glucose, milder hyperketonemia and ketonuria, higher pH and PCO2 at onset than those without remission [14]. Swedish multicenter study showed remissions in 43% of the patients with a median duration of 8 months (range 1-73) [15]. In islet antibody-positive diabetes, normal body weight was the strongest factor for entering remission, whilst a low number of islet antibodies were of importance for the remission duration. Vetter et al. in the present study have used the HbA1c concentration at the time of diagnosis as an indicator of the duration of the remission phase in 23 juvenile diabetic children [16]. The results suggest that the initial HbA1c concentration may serve as a useful indicator to predict the duration of the remission phase in juvenileonset diabetic patients. Researches conducted in recent years indicate that the low prevalence of remission is observed in the youngest children, aged<5 year and in adolescents aged>12 year [17]. It is possible that the low frequency of honeymoon phase in young children reflect more aggressive β-cell destruction in young children. In adolescents insulin resistance contributes to less likelihood of having partial remission. Other authors have similar observations [18]. They asserted that young age and severe disea Continue reading >>

New Diabetes Treatments Aim For Never-ending Honeymoon

New Diabetes Treatments Aim For Never-ending Honeymoon

Type 1 diabetes worsens over time – but like most marriages, it starts with a honeymoon. In type 1 diabetes the honeymoon follows diagnosis. The disease is caused by the loss of insulin-secreting beta cells in the pancreas. Type 1 diabetes can arise at any age, although it often is associated with youth. About half of cases arise in childhood or adolescence. The honeymoon, or remission phase, refers to the period following initial diagnosis when the remaining insulin producing beta cells are functioning well. During this honeymoon, it is easier to control blood sugars, with fewers swings, less risk for hypoglycemia, and lower overall average blood-sugar levels. Stephen Gitelman, MD, who leads clinical trials of new treatments for the UCSF Diabetes Center, would prefer to see the honeymoon never end. His goal is a marriage between newly diagnosed patients and new treatments that could keep type 1 diabetes under control forever. Gitelman, director of the UCSF Pediatric Diabetes Program, is enrolling patients in new clinical trials. Among them is a first-in-humans evaluation of a treatment in which a specific type of cell found in the patient’s own blood, will be removed, purified and grown up in the lab, and then infused back into the patient. “The idea of intervening in new ways at this early stage has really exploded,” Gitelman says. Since 2000, the UCSF Diabetes Center has rapidly accelerated the pace of research and clinical care in diabetes, including playing a significant leadership role in TrialNet, a research program dedicated to the discovery of new therapies to delay, or prevent, the onset of type 1 diabetes in at-risk individuals. Gitelman serves as UCSF's study director for TrialNet, a consortium of investigators from 18 of the leading diabetes institu Continue reading >>

Remission Phase In Paediatric Type 1 Diabetes: New Understanding And Emerging Biomarkers

Remission Phase In Paediatric Type 1 Diabetes: New Understanding And Emerging Biomarkers

Abstract Type 1 diabetes (T1D) is a metabolic disease of unknown aetiology that results from the autoimmune destruction of the β-cells. Clinical onset with classic hyperglycaemic symptoms occurs much more frequently in children and young adults, when less than 30% of β-cells remain. Exogenous insulin administration is the only treatment for patients. However, due to glucose dysregulation, severe complications develop gradually. Recently, an increase in T1D incidence has been reported worldwide, especially in children. Shortly after diagnosis, T1D patients often experience partial remission called “honeymoon phase,” which lasts a few months, with minor requirements of exogenous insulin. In this stage, the remaining β-cells are still able to produce enough insulin to reduce the administration of exogenous insulin. A recovery of immunological tolerance to β-cell autoantigens could explain the regeneration attempt in this remission phase. This mini-review focuses on the remission phase in childhood T1D. Understanding this period and finding those peripheral biomarkers that are signs of immunoregulation or islet regeneration could contribute to the identification of patients with a better glycaemic prognosis and a lower risk of secondary complications. This remission phase could be a good checkpoint for the administration of future immunotherapies. © 2017 S. Karger AG, Basel Type 1 Diabetes and Autoimmunity Type 1 diabetes (T1D) is a metabolic disease caused by the destruction of insulin-producing β-cells by the immune system. It is the commonest endocrine disease in children and adolescents [1], although it can appear at any age. T1D is preceded by a long asymptomatic period (prediabetes) in which immunological tolerance to β-cells is lost. The clinical symptoms Continue reading >>

Remission In Models Of Type 1 Diabetes By Gene Therapy Using A Single-chain Insulin Analogue

Remission In Models Of Type 1 Diabetes By Gene Therapy Using A Single-chain Insulin Analogue

Remission in models of type 1 diabetes by gene therapy using a single-chain insulin analogue Nature volume 408, pages 483488 (23 November 2000) A cure for diabetes has long been sought using several different approaches, including islet transplantation, regeneration of cells and insulin gene therapy 1 . However, permanent remission of type 1 diabetes has not yet been satisfactorily achieved. The development of type 1 diabetes results from the almost total destruction of insulin-producing pancreatic cells by autoimmune responses specific to cells 2 , 3 , 4 , 5 , 6 . Standard insulin therapy may not maintain blood glucose concentrations within the relatively narrow range that occurs in the presence of normal pancreatic cells 7 . We used a recombinant adeno-associated virus (rAAV) that expresses a single-chain insulin analogue (SIA), which possesses biologically active insulin activity without enzymatic conversion, under the control of hepatocyte-specific L-type pyruvate kinase (LPK) promoter, which regulates SIA expression in response to blood glucose levels. Here we show that SIA produced from the gene construct rAAV-LPK-SIA caused remission of diabetes in streptozotocin-induced diabetic rats and autoimmune diabetic mice for a prolonged time without any apparent side effects. This new SIA gene therapy may have potential therapeutic value for the cure of autoimmune diabetes in humans. Towards gene therapy of diabetes mellitus. Continue reading >>

One Year Remission Of Type 1 Diabetes Mellitus In A Patient Treated With Sitagliptin

One Year Remission Of Type 1 Diabetes Mellitus In A Patient Treated With Sitagliptin

Background Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by the autoimmune destruction of pancreatic β-cells in genetically susceptible subjects, which results in absolute insulin deficiency. This pathology is usually diagnosed between the age of 6 months and adulthood, and is clinically manifested through polyuria, polydipsia, and weight loss associated with glycosuria and ketonuria (1). Several agents used to reestablish immunological tolerance over the past few years have successfully prevented and even reverted T1DM in nonobese diabetic mice; however, these outcomes have not been achieved in humans (1). This paper describes the case of a male patient aged 19 who presented with T1DM and whose condition has been remitted for a year, being currently treated only with sitagliptin. Case presentation The case is a 19-year-old male patient from Ciudad Bolívar, Venezuela, without any familial history of diabetes, presented with polyuria, polydipsia, and weight loss (16 kg) with 3 months of evolution. The physical examination showed a weight of 61 kg; a height of 1.71 m; BMI of 20.8 kg/m2; a waist circumference of 76 cm; blood pressure at 100/60 mmHg. Investigation The blood tests showed: fasting blood glucose: 432 mg/dl; HbA1c: 12.3%, basal insulin: 3.2 mUI/ml, C-peptide: 1.2 ng/ml, venous pH: 7.2, bicarbonate: 13 mEq/l, total cholesterol: 178 mg/dl, triglycerides: 196 mg/dl, HDL cholesterol: 41 mg/dl, and LDL cholesterol: 97 mg/dl. Urinalysis revealed glycosuria and ketonuria. Glutamic acid decarboxylase (GAD) antibody resulted positive (46 U/ml, reference range 1–5), but islet cell antibody and anti-insulin tests were negative. Human leukocyte antigen (HLA) genotyping for DR and DQ-encoding loci was carried out by next generation sequencing on the Continue reading >>

Children With Diabetes - Ask The Diabetes Team

Children With Diabetes - Ask The Diabetes Team

My seven year old son, who has had type1 diabetes since age three and a half, has had relatively good hemoglobin A1c results and lately his daily numbers are much improved. In the past six weeks, he has had several instances in which he has had far more food than his insulin injections should have covered (and he has not been exercising), yet his numbers have been low in these cases (below 80 mg/dl [4.4 mmol/L]). Today he had more food than usual for breakfast and less insulin than he usually does and he was low by 9:15 am. Is it at all possible for a child's body to be once again producing some insulin after almost four years of diabetes in which it seemed he was producing none? How long does a honeymoon last? Are there any cases of a spontaneous remission from type 1 diabetes? I have to say at the outset that spontaneous remission does not happen, although there are occasional children who continue to produce some insulin on a long term basis. However, I would have to confess to being somewhat suspicious that your son is manipulating his insulin to be able to eat more. It is also important to bring the recent changes to the attention of your son's diabetes team because he should be checked out for associated (but rare) conditions such as coeliac disease , hypothyroidism , and Addison's disease , all of which can result in unexplained reduction in insulin requirement. Continue reading >>

Partial Remission (honeymoon Phase) In Type 1 Diabetes Mellitus

Partial Remission (honeymoon Phase) In Type 1 Diabetes Mellitus

Sasigarn A. Bowden Abstract Partial remission (‘honeymoon’) phase in type 1 diabetes (T1D) is characterized by a decline in the need for exogenous insulin that starts shortly after the initiation of insulin therapy in newly diagnosed individuals. In some cases, the insulin dose requirement is greatly reduced to almost none while maintaining near normal glycemic control. Results from the Diabetes Control and Complication Trial indicate that preservation of residual β-cell function is associated with not only reduction of long-term clinical micro- and macro-vascular complication but also reduction of acute complications such as hypoglycemia or diabetic ketoacidosis. There has been a recent renewed interest in partial remission because it offers a unique opportunity for pharmacological intervention aiming to completely arrest further destruction process of the β-cells, or best to regenerate the β-cells and thus preserve endogenous insulin secretion. This review summarizes current knowledge on partial remission in T1D, how to define partial remission by clinical criteria and C-peptide measurements, reviews factors associated with partial remission, and provides an update on the interventions to preserve β-cell function to promote or prolong the partial remission phase. Keywords: Type 1 diabetes, Pediatric diabetes, Partial remission, β-cell, Cpeptide. Affiliation: Division of Endocrinology, Department of Pediatrics, Nationwide Children`s Hospital/The Ohio State University, OH 43205, USA. Continue reading >>

Partial Remission (honeymoon Phase) In Type 1 Diabetes Mellitus

Partial Remission (honeymoon Phase) In Type 1 Diabetes Mellitus

Abstract Partial remission ('honeymoon') phase in type 1 diabetes (T1D) is characterized by a decline in the need for exogenous insulin that starts shortly after the initiation of insulin therapy in newly diagnosed individuals. In some cases, the insulin dose requirement is greatly reduced to almost none while maintaining near normal glycemic control. Results from the Diabetes Control and Complication Trial indicate that preservation of residual β-cell function is associated with not only reduction of long-term clinical micro-and macro-vascular complication but also reduction of acute complications such as hypoglycemia or diabetic ketoacidosis. There has been a recent renewed interest in partial remission because it offers a unique opportunity for pharmacological intervention aiming to completely arrest further destruction process of the β-cells, or best to regenerate the β-cells and thus preserve endogenous insulin secretion. This review summarizes current knowledge on partial remission in T1D, how to define partial remission by clinical criteria and C-peptide measurements, reviews factors associated with partial remission, and provides an update on the interventions to preserve β-cell function to promote or prolong the partial remission phase. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Partial Remission (honeymoon phase) in Type 1 dose requirement is greatly reduced to almost none while maintaining near normal that preservation of residual β-cell function is associated with not only reduction of the β-cells, or best to regenerate the β-cells and thus preserve endogenous insulin to define partial remission by clinical criteria and C-peptide measurements, reviews in newly diagnosed individuals Continue reading >>

A Predictive Model For Lack Of Partial Clinical Remission In New-onset Pediatric Type 1 Diabetes

A Predictive Model For Lack Of Partial Clinical Remission In New-onset Pediatric Type 1 Diabetes

A predictive model for lack of partial clinical remission in new-onset pediatric type 1 diabetes Katherine R. Marino , Rachel L. Lundberg , Aastha Jasrotia , Louise S. Maranda , Michael J. Thompson , Bruce A. Barton , Laura C. Alonso , Benjamin Udoka Nwosu Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America Affiliation: Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America * E-mail: [email protected] Affiliation: Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America >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. To determine whether routinely obtai Continue reading >>

Inducing Remission In Type 1 Diabetes With Alefacept (t1dal)

Inducing Remission In Type 1 Diabetes With Alefacept (t1dal)

Subjects in this group receive weekly intramuscular injections of alefacept (15 mg) for 2 cycles of 12 weeks each, separated by a 12 week pause in treatment. Weekly intramuscular injections of alefacept (15 mg) for 2 cycles of 12 weeks each, separated by a 12 week pause in treatment. Subjects in this group received weekly intramuscular injections of a placebo saline solution of equal volume to the alefacept group for 2 cycles of 12 weeks each, separated by a 12 week pause in treatment. Weekly intramuscular injections of a placebo saline solution of equal volume to the alefacept group for 2 cycles of 12 weeks each, separated by a 12 week pause in treatment. Other Name: Inactive drug (pharmacologically) Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information 2-Hour C-peptide Area Under the Curve (AUC) Result in Response to Standardized Mixed Meal Tolerance Test (MMTT) [TimeFrame:Baseline (pre-treatment initiation), Week 52] C-peptide is a substance released by the pancreas into the bloodstream in equal amounts to insulin and reflects how much insulin pancreatic beta cells are making. The standardized MMTT evaluates whether beta cells are producing endogenous insulin. The MMTT was performed in the morning and blood samples for C-peptide collected at baseline (pre-meal) and 15, 30, 60, 90, 120, 150, 180, 210,and 240 minutes post-meal. Results of the stimulated 2-hour (e.g., 120 minutes) post-meal C-peptide AUC are provided. Larger numbers are preferable (better) in these AUC results: more insulin being produced reflects less severe disease. C-peptide levels in the serum (e.g., AUC following a standardized MMTT) compared to control group at 1 year post treatment initiation for the evaluation of inve Continue reading >>

Two-drug Combination Achieves Remission In Mice With Type 1 Diabetes

Two-drug Combination Achieves Remission In Mice With Type 1 Diabetes

Two-drug combination achieves remission in mice with type 1 diabetes Two-drug combination achieves remission in mice with type 1 diabetes MAIT cells identified as treatment target with type 1 diabetes 12 October 2017 A combination of two drugs has shown success in halting the development of type 1 diabetes in a mouse study by French and Danish researchers. Type 1 diabetes develops when the bodys immune system sets itself to destroy the insulin producing cells (known as beta cells) in the pancreas . Researchers dont understand why the immune system chooses to do this but they do know quite a lot about how the immune system goes about killing the cells. Using this knowledge, the researchers were keen to test whether two drugs would be able to block the immune system from killing the pancreas beta cells. The drugs work in different ways and the researchers were keen to test which drug was more effective and how well they worked together. One of the drugs chosen was givinostat, a histone deacetylase inhibitor drug that helps to preserve the working ability of the beta cells . The other drug was otelixizumab , an anti-CD3 monoclonal antibody that helps to hold back the immune attack on the beta cells. The researchers tested each of the drugs against and also tested the two drugs in combination on another group of mice. The goal was to achieve stable remission, which is where the mice were able to maintain normal glucose levels without needing insulin . The mice were given the drugs shortly after developing a form of type 1 diabetes. The results showed that givinostat alone was not able to achieve remission in any of the mice. Otelixizumab was more effective than givinostat alone and achieved remission in 47 per cent of the mice. The most effective treatment was the combinat Continue reading >>

Can Diabetes Be Cured? A Review Of Therapies And Lifestyle Changes

Can Diabetes Be Cured? A Review Of Therapies And Lifestyle Changes

Diabetes is a condition that affects blood sugar levels and causes many serious health problems if not managed well. The health impacts of diabetes can be limited, but can it ever be "cured"? Type 1 diabetes is an autoimmune disease that develops when the body destroys the cells in the pancreas that produce insulin. This means people with type 1 diabetes do not make insulin. In those with type 2 diabetes, there is a decreased sensitivity to insulin and the body does not make or use as much insulin as it needs. Type 2 diabetes is much more common than type 1 diabetes. This article reviews therapies and lifestyle changes that can help reduce the effects of diabetes on a person's health. It also explores whether these treatments can help "cure" diabetes, or if they are simply helpful ways to manage the condition. Contents of this article: Is diabetes curable? Medically speaking, there is no cure for diabetes but it can go into "remission." Diabetes in remission simply means the body does not show any signs of diabetes. However, the disease is technically still there. According to Diabetes Care, remission can take different forms: Partial remission: When a person has had a blood glucose level lower than that of a person with diabetes for at least 1 year without any diabetes medication. Complete remission: When the blood glucose level returns to normal, not simply pre-diabetic levels, for at least 1 year without any medications. Prolonged remission: When complete remission lasts for at least 5 years. Even if a person has had normal blood sugar levels for 20 years, their diabetes is still considered to be in remission rather than "cured." There is no known cure for diabetes. The good news is that remission is possible in many cases and can be as simple as making some lifestyl Continue reading >>

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