An online tool using clinical factors to estimate the probability of partial clinical remission of adult-onset Type 1 diabetes.

Autor: Januszewski AS; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Sydney Pharmacy School, University of Sydney, Sydney, NSW, Australia. Electronic address: andrzej.januszewski@sydney.edu.au., Grzelka-Wozniak A; Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland., Flotynska J; Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland., Jenkins AJ; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia., Zozulinska-Ziolkiewicz DA; Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland., Uruska AA; Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poland.
Jazyk: angličtina
Zdroj: Journal of diabetes and its complications [J Diabetes Complications] 2024 Sep; Vol. 38 (9), pp. 108828. Date of Electronic Publication: 2024 Jul 27.
DOI: 10.1016/j.jdiacomp.2024.108828
Abstrakt: 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.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: