Poznan University of Medical Sciences, Poznan, Poland.
Diabetes Technol Ther. 2020 Aug;22(8):577-583. doi: 10.1089/dia.2019.0473. Epub 2020 May 19.
Clinical remission of type 1 diabetes is not only associated with regeneration of beta cells and preserved insulin secretion but also with increased insulin sensitivity. The aim of the study was to determine the association between presence of remission in the first year of type 1 diabetes and insulin resistance at 7 years from diagnosis of the disease. A total of 108 consecutive patients with newly diagnosed type 1 diabetes were followed prospectively. During the follow-up time, the onset and duration of clinical remission were registered. Seventy-four patients were included in the final analysis. Insulin sensitivity was assessed by the glucose disposal rate (GDR), determined using the hyperinsulinemic-euglycemic clamp, performed at 7 years from diagnosis of diabetes. Patients were divided into groups with GDR <4.5 mg/(kg·min) (G1-lower insulin sensitivity group) and GDR ≥4.5 mg/(kg·min) (G2-higher insulin sensitivity group). Higher insulin sensitivity was observed in the remission group [GDR 6.2 interquartile range (IQR) 4.2-7.0 mg/(kg·min) vs. 3.8 (IQR 3.0-4.8) mg/(kg·min); = 0.01]. Furthermore, in G2 group, the duration of remission was longer than in G1 group: (351 [IQR 206-561] days vs. 70 [IQR 0-289] days; = 0.002). Also, the GDR value correlated positively with duration of remission ( = 0.42; = 0.002). In the multivariate logistic regression model, including age, sex, body mass index at diagnosis, and presence of remission, the remission period was independently associated with a higher GDR value (odds ratio 10.88; 95% confidence interval: 1.70-69.50; = 0.009]. Patients with type 1 diabetes who entered remission at the beginning of the disease, despite its ending, have higher insulin sensitivity at 7 years after diagnosis of diabetes than nonremitters.
1 型糖尿病的临床缓解不仅与β细胞再生和胰岛素分泌功能保存有关，还与胰岛素敏感性增加有关。本研究旨在确定 1 型糖尿病发病后 1 年内的缓解状态与疾病诊断后 7 年的胰岛素抵抗之间的关系。连续纳入 108 例新诊断的 1 型糖尿病患者进行前瞻性随访。在随访期间，记录临床缓解的发生和持续时间。最终有 74 例患者纳入最终分析。采用高胰岛素-正葡萄糖钳夹技术评估葡萄糖处置率（GDR）以评估胰岛素敏感性，检测时间为糖尿病诊断后 7 年。根据 GDR＜4.5mg/（kg·min）（G1-低胰岛素敏感性组）和 GDR≥4.5mg/（kg·min）（G2-高胰岛素敏感性组）将患者分为两组。缓解组的胰岛素敏感性更高[GDR 中位数（IQR）为 6.2（4.27.0）mg/（kg·min）比 3.8（3.04.8）mg/（kg·min）； = 0.01]。此外，G2 组的缓解持续时间长于 G1 组[（351[IQR 206561]d 比 70[IQR 0289]d； = 0.002]）。此外，GDR 值与缓解持续时间呈正相关（ = 0.42； = 0.002）。在包含年龄、性别、诊断时体重指数和缓解状态的多变量 logistic 回归模型中，缓解期与较高的 GDR 值独立相关（比值比 10.88；95%置信区间：1.70~69.50； = 0.009]）。尽管缓解结束，但在疾病开始时进入缓解的 1 型糖尿病患者在糖尿病诊断后 7 年时的胰岛素敏感性高于未缓解者。
