The "Honeymoon Phase" in Children with Type 1 Diabetes Mellitus (T1DM): Frequency, Duration and Predictive Factors at Onset

Abstract: Aim of thè study was: to analyze thè epidemiological features of paediatric T1DM at onset and their relation to remission frequency and duration in thè first year of disease, to assess clinical effìcacy of Glucose Evaluation Trial REMission (GETREM) protocol in terms of induction and maintenance of thè "honeymoon phase" and to evaluate Insulin Dose-Adjusted A1C values at onset [IDAA1C = HbAlc% + (Insulin U/Kg/die x 4)] as a predictor of remission. 181 patients less than 15 years of age were admitted at our Department for T1DM onset and were treated according to GETREM protocol in thè years 2008-2011. The following data were recorded at onset: age, sex, modality of onset according to ISPAD criteria, HbAlc, IDAA1C, fasting Cpeptide and insulin requirement at thè time of discharge. We considered as result variables both thè percent of patients who achieved remission according to ISPAD criteria anytime during thè first year of follow-up and remission duration in months for each patient. Clinical and lab parameters at onset were analyzed as predictors of remission in both forms by software R, R Development Gore Team 2011. 46% of patients achieved partial or total remission during first year of follow up; in these patients mean remission duration was 7.22 months (SD 2.81 m). Variables at onset that were significantly related to remission were: - Age higher than 3 years: (% remission 53.2% vs 0%, p = 7.17 x 10-7) - Modality of onset: chetosis vs chetoacidosis (% remission 53.8% vs 34.7%, p = 0.01; mean duration of remission, if achieved, 7.7 vs 6.19 m, p = 0.03) - IDAA1C: a significant correlation was found between EDAA1C at onset and months of remission (p = 1.83 x 10-6, R2 = 0.12). We conclude that age under 3 years and severe metabolic impairment at onset are associated with lower rate and duration of remission in thè first year of disease. Therefore we suggest considering early diagnosis and intensive treatment at onset as thè potential goal to induce prolonged and/or complete remission phase.