Evaluation of Clinical Remission in IDDM Patiets Treated With Intravenous Insulin at Onset: Three years follow-up results

ABSTRACT
It has been suggested that strict metabolic control starting from the first weeks of insulin dependent diabetes (IDDM) is a major factor achieving clinical remission. This is usually accompanied with an increase in C-peptide secretion. Long term benefit of remisson might be related with the prevention and/or at least reduction in the rate of development of late diabetic complications. To achieve good metabolic control, intensified insulin therapy and blood glucose monitoring accompanied to a well-planned dietary regimen and physical exercise are crucial elements. Home blood glucose monitoring has been shown to be also an important factor to obtain such a good metabolic control. Aims of this prospective pilot study were a) to evaluate the frequency and duration of clinical remission in newly diagnosed IDDM patients who were followed up for a period of 36 months using a unique protocol without any adjunctive immun-intervention; b) to identify the predictive factors for remission in IDDM patients . 10 newly diagnosed IDDM patients (4 females, 6 males; mean chronological age: 14.8±6.3 yrs) who were classified WHO criteria were included in this study to test the efficacy of intensive insulin therapy (IIT) in achieving clinical remission of the disease. Patients were treated with intravenous insulin infusion at diagnosis for 2-4 days and then IIT was continued with four daily injections. A complete remission (CR) was observed in 50% of cases (5 patients); additionally in three patients insulin requirements reduced to an incomplete remission (ICR) level (30%) No remission (NR) was obtained in the remaining two (20%). Based on remission status, initial characteristics [sex, F/M, mean age onset(years), basal / stimulated C-peptide levels (ng/ml)] were as follows. In CR Group: 1/ 4, 19.1, 1.08± 0.35/ 1.82± 0.4; In ICR Group: 3/ 0, 15.4, 0.61± 0.43 / 1.01±0.56;: In NR Group; 2/ 0, 13.8, 0.28±0.20 / 0.46 ± 0.19, respectively. All groups were evaluated at 3., 6., 12., 24. and 36. months in terms of remission status and beta cell insulin capacity. Mean length of the remission in CR group was 12.4 months . Remission for more than 2 years in one case. In conclusion, this study indicated that remission phenomenon is more frequent than expected without immune-intervention. Older age at onset, male gender and higher initial C- peptide levels seemed to be a predictive of clinical remission in IDDM patients.