Nwosu Benjamin Udoka
Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Eur Med J Diabetes. 2019 Mar;4(1):89-98. Epub 2019 Mar 14.
The honeymoon phase, or partial clinical remission (PCR) phase, of Type 1 diabetes mellitus (T1DM) is a transitory period that is marked by endogenous insulin production by surviving 3 cells following a diabetes diagnosis and the introduction of insulin therapy. It is a critical window in the course of the disease that has short and long-term implications for the patient, such as a significant reduction in the risk of long-term complications of T1DM. To promote long-term cardiovascular health in children with newly diagnosed T1DM, three key steps are necessary: the generation of a predictive model for non-remission, the adoption of a user-friendly monitoring tool for remission and non-remission, and the establishment of the magnitude of the early-phase cardiovascular disease risk in these children in objective terms through changes in lipid profile. However, only about 50% of children diagnosed with T1DM experience the honeymoon phase. Accurate and prompt detection of the honeymoon phase has been hampered by the lack of an objective and easily applicable predictive model for its detection at the time of T1DM diagnosis, the complex formulas needed to confirm and monitor PCR, and the absence of a straightforward, user-friendly tool for monitoring PCR. This literature review discusses the most up-to-date information in this field by describing an objective predictive model for non-remission, an easy tool for monitoring remission or non-remission, and objective evidence for the cardiovascular protective effect of PCR in the early phase of the disease. The goal is to present non-remission as an independent clinical entity with significantly poorer long-term prognosis than partial remission.
1型糖尿病（T1DM）的蜜月期，即部分临床缓解（PCR）期，是一个过渡阶段，其特征是在糖尿病诊断并开始胰岛素治疗后，存活的β细胞产生内源性胰岛素。这是疾病进程中的一个关键窗口期，对患者有短期和长期影响，比如可显著降低T1DM长期并发症的风险。为促进新诊断T1DM儿童的长期心血管健康，需要采取三个关键步骤：生成非缓解的预测模型、采用便于用户使用的缓解和非缓解监测工具，以及通过血脂谱变化客观确定这些儿童早期心血管疾病风险的程度。然而，只有约50%被诊断为T1DM的儿童会经历蜜月期。由于在T1DM诊断时缺乏客观且易于应用的蜜月期检测预测模型、确认和监测PCR所需的复杂公式，以及缺乏用于监测PCR的简单、便于用户使用的工具，蜜月期的准确及时检测受到了阻碍。这篇文献综述通过描述非缓解的客观预测模型、监测缓解或非缓解的简易工具以及疾病早期PCR心血管保护作用的客观证据，讨论了该领域的最新信息。目的是将非缓解呈现为一个独立的临床实体，其长期预后明显比部分缓解差。
