The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon).

Gulsum Ozen,Emanuele Miraglia Del Giudice,Francesca Casaburo,Gulsah Ozen,Alessia Piscopo,Medine Aysin Tasar,Dario Iafusco,Santino Confetto,Fernanda Iafusco,Nadia Tinto,Angela Zanfardino,Arzu Yilmaz

doi:10.1155/2020/2630827

Abstract

Type 1 diabetes mellitus (DM) is characterized by irreversible, autoimmune, pancreatic β-cell destruction. During the disease, some patients experience a phase of Partial Clinical Remission (PCR) known as “honeymoon.” This is a transitory period that is characterized by insulin production by residual β cells following DM diagnosis and initiating the insulin therapy. In this study, we aimed to evaluate the influence of insulin production on immune system after the onset of diabetes, and we showed that the duration of honeymoon period could be related to the onset of other autoimmune conditions. For this retrospective study, 159 children aged between 11 and 18 years with type 1 DM were eligible. They have been diagnosed diabetes at least 10 years ago and use exogenous insulin. Our results showed that younger age at the onset of Type 1 DM in children, predicts Celiac Disease. Female sex and low HCO3 levels at the onset of DM had a high predictive value on patients who did not experience longer Partial Clinical Remission phase. Patients with higher BMI at the diagnosis of DM experienced shorter honeymoon period than the average. Smaller of our patients who diagnosed just DM have more than 297 days honeymoon period with respect to patients with one associated autoimmune disease. This may be due to a continuous and prolonged stimulation of immune system during the period of honeymoon that predispose the patient to develop other TH1 diseases. The patients who experienced more than 297 days Partial Clinical Remission seem under risk of developing one other autoimmune disease more than the patients who experienced less than 297 days Partial Clinical Remission. We have to consider that this observation is very intriguing because many protocols spring-up to try prolonging the honeymoon period in patients with autoimmune DM. If this aim is important from a metabolic point of view, long follow-ups are needed to be sure that the risk of other autoimmune diseases does not increase.

Highlights

Type 1 diabetes mellitus (DM) is a chronic illness known as insulin-dependent diabetes and characterized by irreversible, autoimmune, insulin producing islet β-cell destruction
E cause of Type 1 diabetes mellitus is unknown, genetic, immunologic, and environmental factors are known to increase the risk for its development. ese suspected factors are mainly determined by the HLA genes which are located on chromosome 6, viral infections such as German measles, coxsackie and mumps, geography, family history, diet, stress events, perinatal factors, and other autoimmune conditions such as Hashimoto thyroiditis, multiple sclerosis, pernicious anemia, Sjogren’s syndrome, idiopathic thrombocytopenic purpura, vitiligo, dermatitis
We aimed to evaluate the influence of the residual production of insulin on immune system after the onset of diabetes and if the duration of honeymoon period could be related to the onset of other autoimmune conditions

Summary

Introduction

Type 1 diabetes mellitus (DM) is a chronic illness known as insulin-dependent diabetes and characterized by irreversible, autoimmune, insulin producing islet β-cell destruction. It is a transitory period that is marked by significant amount of endogenous insulin production by residual β cells following diabetes mellitus diagnosis and initiating the insulin therapy. During this phase, patients may require progressive smaller doses of insulin for good glycemic control. E patients diagnosed with type 1 DM were examined at each control and practised autoimmune thyroiditis and celiac disease antibodies twice in a year in the first two years after DM diagnosis and once a year. We have used automatic mechanical calculator and electronic patient diaries for 5 years, we did not have the possibility to calculate glycemic values automatically more than 10 years ago In those days, the only method available in Italy was traditional paper diaries monthly. 19.35 59.68 0.4 3.59 12.33 Range: 10.31–15.94 nonparametric Mann–Whitney tests for continuous variables, and Chi-squared tests or Fisher exact tests for extreme proportions for categorical variables

Results

15.4 M: 58 F

Conclusions