Tip 1 Diabetes Mellitus Tanılı Çocuklarda Remisyon (Balayı) Döneminin İzlemde Vücut Kompozisyonu Ve İnsülin Duyarlılığı Üzerine Etkisi

Abstract

Type 1 diabetes mellitus (T1DM) is a chronic disease that causes insulin deficiency due to autoimmune destruction of beta cells. Remission (honeymoon period) in T1DM is a temporary recovery period that begins within the first 3-6 months after diagnosis and usually lasts 6-9 months, during which insulin requirements decrease and insulin sensitivity increases. Individuals in remission during childhood have been reported to have better short-term metabolic control and fewer microvascular complications in adulthood. It has also been suggested that remission has protective effects against dyslipidemia and obesity, which are cardiovascular risk factors. However, the long-term effects of remission are still unclear. This study aims to investigate the significance of the remission period in diabetes management by examining its effects on body composition, insulin sensitivity, glycaemic control and cardiovascular risk factors in the medium-term. The study was conducted as a retrospective cohort study of 63 children aged 5-18 years with a diagnosis of type 1 diabetes mellitus (T1DM) for at least one year between March 2022 and April 2023 at Hacettepe University, Department of Paediatric Endocrinology. Patients were divided into groups according to their remission status and compared. Remission status and duration were determined by IDAA1c score (IDAA1c ≤ 9 was considered as remission). The study examined the demographic, clinical, laboratory and anthropometric characteristics of the patients at the time of diagnosis. In addition, it examined changes in insulin sensitivity indicators, diabetic control and anthropometric measurements in three-month periods during the first year after diagnosis. The study also involved body composition analysis using the segmental multi-frequency body analyzer Tanita MC-780 MA, and cardiovascular risk factors at the last control. Remission was achieved in 39.7% of patients in the study. The remission rates were 33.3% in girls and 46.7% in boys. The median duration of remission was 7.5 months and exit from remission occurred at the end of the first year after diagnosis. Patients in remission had lower HbA1c, insulin and IDAA1c levels and higher C-peptide and glucose/insulin ratios at diagnosis. A significant decrease in HbA1c, IDAA1c and insulin requirement was observed in the first 3-6 months after diagnosis. At follow-up, the remission group was found to have better glycaemic control and insulin sensitivity. Patients in remission had a lower BMI SDS than those who did not go into remission. BMI SDS showed a significant increase in the first three months in both groups, continued to increase at a slower rate between the third and sixth months, and remained stable over four years. The proportion of overweight/obese patients increased from 14.3% at diagnosis to 30.2% at four years. These rates were similar between the remission and non-remission groups. BMI SDS, waist circumference SDS, FMI and FMI z-scores were lower in patients in remission during the last follow-up visit, a median of 3.3 years after diagnosis. Increased insulin sensitivity was significantly negatively correlated with body fat indicators (BMI SDS, triceps skinfold thickness, total body fat percentage, FMI z-score). In particular, the strong negative correlation between subscapular skinfold thickness SDS and insulin sensitivity indicates the impact of insulin resistance on visceral adiposity. In the medium-term, the remission group showed a protective effect on body composition, especially on adiposity. Median triglyceride, non-HDL cholesterol levels and triglyceride/HDL ratio were lower in the remission group. There was a significant positive correlation between FMI z-score and triglycerides, VLDL, LDL, non-HDL cholesterol and triglyceride/HDL ratio. There was a strong positive correlation between subscapular skinfold thickness SDS and triglycerides, VLDL and triglycerides/HDL ratio. These data showed that the remission group had a favourable lipid profile with lower adiposity rates. Girls in remission had lower BMI SDS, waist circumference SDS and skinfold thickness compared to girls not in remission. They also had a lower total body fat percentage. With regard to the lipid profile, it was observed that the girls in remission exhibited lower levels of triglycerides, LDL, non-HDL cholesterol, and a lower triglyceride-to-HDL ratio, whilst simultaneously demonstrating higher levels of HDL. Boys in remission demonstrated a balanced muscle and fat distribution, despite exhibiting higher BMI-SDS values. In contrast, leanness and muscle loss were observed in boys failing to go into remission. No significant differences were observed in the lipid profile. Insulin sensitivity scores were higher in patients in remission in both sexes. In conclusion, partial remission in children with T1DM has beneficial effects on body composition, insulin sensitivity and metabolic control in the short and medium-term, remission status has different effects depending on gender, and therefore dyslipidaemia and hypertension should be screened early and treatment should be individualised according to gender differences.