Redefining the clinical remission period in children with type 1 diabetes

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Abstract
Purpose: To redefine the clinical remission period for different aged children receiving the current standard of diabetes care. Methods: An electronic patient records system was used to identify 552 children newly diagnosed with type 1 diabetes (T1D) from 1997 to 2001 who had an initial hemoglobin A1c (HbA1c) value at the time of diagnosis and at least one other value measured in the ensuing year. The insulin dosage previously used to define the remission period [0.5 U/kg/d by 9 months after diagnosis. The mean HbA1c values were above 8% by 6 months after diagnosis for the 6–9 and the 10–12 yr age groups and by 9 months after diagnosis for the ≥13 yr age group. The percentage of children ≤5 yr of age who continued to receive <0.5 U/kg/d of insulin was higher than for the other three age groups. However, this group did not achieve a mean HbA1c value <8% at any time. Conclusion: Older children have a longer remission period than younger children. The clinical definition of the remission period should be redefined to include both the insulin dose and the HbA1c level. Any attempt to extend the remission period in children is more apt to be successful in dealing with older children and with the introduction of the intervention as soon after diagnosis as is feasible.