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

Abstract

IntroductionPrevalence 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 MethodsNinety-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% (48mmol/mol), daily insulin requirement below 0.3 U/kg body weight and serum Cpeptide concentration above 0.5ng/ml. Patients were divided into those who were in remission at any time during follow-up (remitters) and non-remitters. After 7years 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. ResultsIn 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 7years [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. ConclusionsOccurrence of partial remission of diabetes is associated with a reduced risk of chronic microvascular complications at 7-year follow-up.