Clinical Remission of Type 1 Diabetes Predicts Higher Insulin Sensitivity at 7 Years from Diagnosis of the Disease

Abstract

Background:

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.

Material and Methods:

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).

Results:

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); P = 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; P = 0.002). Also, the GDR value correlated positively with duration of remission (r = 0.42; P = 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; P = 0.009].

Conclusions:

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.