NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Sydney Pharmacy School, University of Sydney, Sydney, NSW, Australia.
Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland.
J Diabetes Complications. 2024 Sep;38(9):108828. doi: 10.1016/j.jdiacomp.2024.108828. Epub 2024 Jul 27.
A type 1 diabetes (T1D) diagnosis is often followed by a period of reduced exogenous insulin requirement, with acceptable glucose control, called partial clinical remission (pCR). Various criteria exist to define pCR, which is associated with better clinical outcomes. We aimed to develop formulae and a related online calculator to predict the probability of pCR at 3- and 12-months post-T1D diagnosis. We analysed data from 133 adults at their T1D diagnosis (mean ± SD age: 27 ± 6 yrs., HbA1c 11.1 ± 2.0 %, 98 ± 22 mmol/mol), 3- and 12-months later. All patients were enrolled in the prospective observational InLipoDiab1 study (NCT02306005). We compared four definitions of pCR: 1) stimulated C-peptide >300 pmol/l; 2) insulin dose-adjusted HbA1c ≤9 %; 3) insulin dose <0.3 IU/kg/24 h; and HbA1c ≤6.4 % (46 mmol/mol); and 4) insulin dose <0.5 IU/kg/24 h and HbA1c <7 % (53 mmol/mol). Using readily available demographics and clinical chemistry data exhaustive search methodology was used to model pCR probability. There was low concordance between pCR definitions (kappa 0.10). The combination of age, HbA1c, diastolic blood pressure, triglycerides and smoking at T1D onset predicted pCR at 12-months with an area under the curve (AUC) = 0.87. HbA1c, triglycerides and insulin dose 3-mths post-diagnosis had an AUC = 0.89. A related calculator for pCR in adult-onset T1D is available at http://www.bit.ly/T1D-partial-remission.
1 型糖尿病（T1D）诊断后通常会出现一段时间的外源性胰岛素需求减少，同时血糖控制可接受，称为部分临床缓解（pCR）。存在各种定义 pCR 的标准，其与更好的临床结果相关。我们旨在开发公式和相关在线计算器，以预测 T1D 诊断后 3 个月和 12 个月时 pCR 的概率。我们分析了来自 133 名成年人在 T1D 诊断时的数据（平均 ± 标准差年龄：27 ± 6 岁，HbA1c 11.1 ± 2.0%，98 ± 22 mmol/mol），3 个月和 12 个月后。所有患者均纳入前瞻性观察性 InLipoDiab1 研究（NCT02306005）。我们比较了 pCR 的四种定义：1）刺激 C 肽>300 pmol/l；2）胰岛素剂量调整后的 HbA1c ≤9%；3）胰岛素剂量<0.3 IU/kg/24 h；和 HbA1c ≤6.4%（46 mmol/mol）；4）胰岛素剂量<0.5 IU/kg/24 h 和 HbA1c <7%（53 mmol/mol）。使用易于获得的人口统计学和临床化学数据，采用穷举搜索方法对 pCR 概率进行建模。pCR 定义之间的一致性较低（kappa 0.10）。T1D 发病时的年龄、HbA1c、舒张压、甘油三酯和吸烟的组合可预测 12 个月时的 pCR，曲线下面积（AUC）为 0.87。诊断后 3 个月的 HbA1c、甘油三酯和胰岛素剂量的 AUC 为 0.89。成人发病的 T1D 中 pCR 的相关计算器可在 http://www.bit.ly/T1D-partial-remission 获得。
