Immunology Section, Germans Trias i Pujol Research Institute and University Hospital, Badalona, Spain.
Pediatrics Section, Germans Trias i Pujol Research Institute and University Hospital, Badalona, Spain.
Horm Res Paediatr. 2017;88(5):307-315. doi: 10.1159/000479030. Epub 2017 Aug 3.
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.
1 型糖尿病（T1D）是一种病因不明的代谢性疾病，由β细胞的自身免疫性破坏引起。具有典型高血糖症状的临床发病多见于儿童和青年，此时β细胞残留不足 30%。外源性胰岛素治疗是患者的唯一治疗方法。然而，由于血糖调节紊乱，严重的并发症逐渐发展。最近，全世界都报告 T1D 的发病率有所增加，尤其是在儿童中。T1D 患者在诊断后不久经常经历称为“蜜月期”的部分缓解，持续数月，对外源胰岛素的需求较少。在此阶段，剩余的β细胞仍能够产生足够的胰岛素来减少外源性胰岛素的给药。对β细胞自身抗原免疫耐受的恢复可以解释该缓解期的再生尝试。本篇迷你综述重点关注儿童 T1D 的缓解期。了解这一时期并发现那些外周生物标志物是免疫调节或胰岛再生的标志，可能有助于确定那些具有更好血糖预后和较低继发并发症风险的患者。该缓解期可能是未来免疫疗法应用的一个良好检查点。
