Ozen Gulsum, Zanfardino Angela, Confetto Santino, Piscopo Alessia, Casaburo Francesca, Tinto Nadia, Iafusco Fernanda, Ozen Gulsah, Miraglia Del Giudice Emanuele, Tasar Medine Aysin, Yilmaz Arzu, Iafusco Dario
Department of Pediatrics, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey.
Regional Centre for Pediatric Diabetes, Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy.
Int J Endocrinol. 2020 Jan 4;2020:2630827. doi: 10.1155/2020/2630827. eCollection 2020.
Type 1 diabetes mellitus (DM) is characterized by irreversible, autoimmune, pancreatic -cell destruction. During the disease, some patients experience a phase of Partial Clinical Remission (PCR) known as "." This is a transitory period that is characterized by insulin production by residual 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 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 HCO 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.
1型糖尿病（DM）的特征是不可逆的自身免疫性胰腺β细胞破坏。在疾病过程中，一些患者会经历一个称为“蜜月期”的部分临床缓解（PCR）阶段。这是一个短暂的时期，其特征是在DM诊断并开始胰岛素治疗后，残余β细胞产生胰岛素。在本研究中，我们旨在评估糖尿病发病后胰岛素产生对免疫系统的影响，并且我们表明蜜月期的持续时间可能与其他自身免疫性疾病的发生有关。对于这项回顾性研究，159名年龄在11至18岁之间的1型DM儿童符合条件。他们至少在10年前被诊断出患有糖尿病并使用外源性胰岛素。我们的结果表明，儿童1型DM发病时年龄较小，预示着患有乳糜泻。DM发病时女性性别和低HCO水平对未经历较长部分临床缓解期的患者具有较高的预测价值。DM诊断时BMI较高的患者蜜月期比平均水平短。仅诊断为DM的患者与患有一种相关自身免疫性疾病的患者相比，有超过297天的蜜月期。这可能是由于蜜月期免疫系统受到持续和长期的刺激，使患者易患其他TH1疾病。经历超过297天部分临床缓解的患者比经历少于297天部分临床缓解的患者似乎更有患另一种自身免疫性疾病的风险。我们必须考虑到这一观察结果非常有趣，因为许多方案涌现出来试图延长自身免疫性DM患者的蜜月期。如果从代谢的角度来看这个目标很重要，那么需要长期随访以确保其他自身免疫性疾病的风险不会增加。
