'The honeymoon phase' in children with type 1 diabetes mellitus: frequency, duration, and influential factors

Background: The honeymoon period (i.e., partial remission) of type 1 diabetes mellitus is characterized by reduced insulin requirements while good glycemic control is maintained. The clinical significance is the potential possibility for pharmacological intervention during this period to either slow down or arrest the ongoing destruction of the remaining beta-cells. Methods: A group of 103 diabetic children, younger than 12 yr of age, were prospectively studied to assess the frequency, duration, and factors that may affect partial remission. At the time of admission, patients were characterized by age, gender, symptom duration, diabetic ketoacidosis (DKA), and blood sugar level at admission. The honeymoon period was defined as a period with insulin requirements of less than 0.5 U/kg/day and hemoglobin A1c (HbA1c) level of less or equal to 6%. Results: Partial remission occurred in 71, being complete in three. The length of time until remission was 28.6 +/- 12.3 (mean +/- SD) days. The duration of remission was 7.2 +/- 4.8 months. Remission rates were higher in those patients older than 5 yr compared with those between 3 and 5 yr of age. DKA at presentation and long duration of symptoms were associated with lower duration of remission (p < 0.001 and p < 0.001, respectively). Children in whom remission occurred had significantly lower blood glucose levels and higher pH at presentation (p < 0.001 and p < 0.001, respectively). Conclusions: Young age and severe disease at presentation are associated with decreased residual beta-cells function that is reflected by a lower incidence of partial remission. These observations are important to consider in the research regarding therapies that will have the potential goal to induce prolonged and/or complete remission at disease onset or shortly thereafter.