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Determining Which Type 1 Patients Will Experience A Partial Remission

Sep 12, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Joel John, Pharm.D. Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Study found likelihood of a type 1 diabetes patient experiencing partial remission was affected by gender and age at diagnosis, among other factors. 

Type 1 diabetes, also called juvenile diabetes, is when the pancreas creates almost no insulin. Some of the symptoms associated with type 1 diabetes include excessive thirst, excessive urination, weight loss, fatigue, and more. Children, adolescents, and even adults can be diagnosed with type 1 diabetes. After a person is diagnosed and started on insulin therapy, there is potentially a period of time in which partial remission can be achieved through the temporary restoration of betacell function. The After Diagnosis Diabetes Research Support System-2 (ADDRESS-2) study analysis has the aim of identifying what factors play a role in this partial remission.  

This study is a prospective, observational study that is still on-going throughout England and Wales. The study currently has over 5,000 children and adult participants who have been diagnosed with type 1 diabetes. The participants are found through the UK National Institute for Health Research Clinical Research Network. Children that are younger than five years old were excluded from this study. Measurements are taken at the start of the study and 4-8 months after. Some of the measurements that were taken include ethnicity, gender, age, weight, family history of diabetes, HbA1c, symptoms, ketoacidosis presentation, and current medications.  

Of the 3,312 participants that were included in data analysis, 1,470 had at least one result showing that they achieved remission status. Of those people, 469 people had two results showing that they reached remission status. Both results came within 12 months of the participants getting diagnosed with type 1 diabetes. The chances that someone goes into remission were about the same in patients between the ages of 5 and 19; however, this percentage jumps to 27% in patients from the ages of 20 to 27 years old. Patients between 27.3 and 34.4 years old have a remission percentage rate of 29%. The remission rate then drops back to 20% after 34.4 years old. Remission rates were higher between months 3 and 12 for both older and younger participants. In the younger population (less than 20 years old), there was a 10 to 20 percent remission rate from 3-12 months after diagnosis. In the older population group (at least 20 years old), there was a 20 to 44 percent remission rate for the same period. It was also noted that males were more likely to be in remission compared to females. 

Additionally, if patients experienced ketoacidosis, osmotic symptoms, weight loss, or fatigue, then they were less likely to be in remission. All the above characteristics were indicators in the younger population, but not for the older participants. The number of patients who met remission twice versus only once was more than double in the older population.  

Some previous studies have looked at similar questions but with more extended follow-up periods. One aspect that could have improved this trial was increasing the amount of time after diagnosis in which they checked for remission. Having only one year after diagnosis can skew the results. The question that was being asked was, “how many people can go into remission within one year of diagnosis?” but the researchers should conduct a follow-up trial in which the same question is asked. The strengths of this trial include a variety of participants as well as clearly defined endpoints and characteristics that dictate the results of this trial.  

Practice Pearls: 

  • This study showed that people who are diagnosed with type 1 diabetes are more likely to experience remission if they are diagnosed after the age of 20.  
  • Certain factors like the presence of ketoacidosis, gender, and symptoms can play a role in whether a person achieves remission or not. 
  • More studies need to be done to see if these factors alter remission rates after one year of being diagnosed with type 1 diabetes.   

 

Humphreys, Anna, and et al. 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 and Clinical Practice, 2019 Elsevier BVJuly 19, 2019, https://doi.org/10.1016/j.diabres.2019.107789.  

 

Joel John, Pharm.D. Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences