Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.
Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, National Clinical Research Center for Metabolic Diseases, Changsha, China.
J Diabetes. 2020 Oct;12(10):761-768. doi: 10.1111/1753-0407.13044. Epub 2020 Apr 20.
Partial remission (PR) is a special stage in type 1 diabetes (T1D). The different patterns of PR frequency, characteristics, and determinants in juvenile and adult patients are unclear, and data on Chinese are lacking.
A total of 186 children and 114 adults with T1D who were regularly followed up in a cohort were included for analysis. PR was defined according to C-peptide ≥300 pmol/L or index of insulin dose-adjusted hemoglobin A1c ≤9, as previously recommended. C-peptide and islet autoantibodies were determined with chemiluminescence and radioimmunoassay, respectively.
The frequency of PR in children was higher than that in adults, with the proportion being 69.9% and 58.8%, respectively (P < .05). For juvenile-onset T1D, the frequency of PR gradually decreased as the onset age decreased, from 87.5% in 13- to 18-year olds to 46.5% in under 6-year olds. Multivariable analyses showed that onset age and male sex were positively related with the frequency of PR in children, while the related factors in adults were initial glycosylated hemoglobin A1c and C-peptide levels. The median PR duration was similar in children (14.8 ± 1.2 months) and adults (16.4 ± 1.9 months). Older onset age was related with a longer PR duration in children, but no such associations were found in adult individuals.
Children and adults with T1D have different patterns on PR frequency, clinical characteristics, and determinants. For patients during this special phase, the relatively high C-peptide level and to reduce insulin dosage accordingly should be emphasized in clinical practice.
部分缓解（PR）是 1 型糖尿病（T1D）的一个特殊阶段。青少年和成年患者 PR 频率、特征和决定因素的不同模式尚不清楚，且缺乏中文数据。
共纳入 186 例儿童和 114 例定期随访的成年 T1D 患者进行分析。根据先前推荐的 C 肽≥300 pmol/L 或胰岛素剂量调整后的糖化血红蛋白指数≤9 定义 PR。C 肽和胰岛自身抗体分别采用化学发光和放射免疫法测定。
儿童 PR 的频率高于成年人，比例分别为 69.9%和 58.8%（P<0.05）。对于青少年起病的 T1D，PR 的频率随着发病年龄的降低而逐渐降低，从 13-18 岁的 87.5%降至 6 岁以下的 46.5%。多变量分析显示，发病年龄和男性与儿童 PR 的频率呈正相关，而成年人的相关因素为初始糖化血红蛋白 A1c 和 C 肽水平。儿童（14.8±1.2 个月）和成人（16.4±1.9 个月）PR 的中位持续时间相似。发病年龄较大与儿童 PR 持续时间较长相关，但在成年个体中未发现这种关联。
T1D 儿童和成人的 PR 频率、临床特征和决定因素存在差异。对于处于这一特殊阶段的患者，临床实践中应强调相对较高的 C 肽水平，并相应减少胰岛素剂量。
