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Integration of Routine Parameters of Glycemic Variability in a Simple Screening Method for Partial Remission in
Nina Nielens1, Olivier Pollé1, Annie Robert2
1Pediatric Endocrinology Unit, Cliniques Universitaires Saint Luc, Av. Hippocrate 10, 1200 Brussels, Belgium.
Insights
A new formula, GTAA1C, effectively identifies partial remission in type 1 diabetes using routine glycemic variability markers. This method offers a reliable alternative to existing criteria for pediatric patients.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pediatric Diabetes Management
Background:
- Partial remission in type 1 diabetes (T1D) is crucial for long-term outcomes.
- Existing criteria like IDAA1C correlate with beta-cell function but have limitations.
- Defining partial remission using readily available clinical data is needed.
Purpose of the Study:
- To identify clinical variables associated with IDAA1C-defined partial remission in pediatric T1D.
- To evaluate glycemic variability parameters for defining partial remission.
- To propose a novel, accessible formula for partial remission in T1D.
Main Methods:
- Retrospective analysis of 239 pediatric T1D patients.
- Evaluation of clinical features and glycemic variability parameters (HbA1C, normoglycemia).
- Development and validation of the Glycemic Target-Adjusted HbA1C (GTAA1C) formula.
Main Results:
- Diabetic ketoacidosis and age at diagnosis influenced partial remission.
- HbA1C levels and percentage of normoglycemia reliably predicted partial remission.
- The GTAA1C formula showed high sensitivity (72.3%) and specificity (92%) for predicting partial remission, correlating well with IDAA1C and BETA-2 scores.
Conclusions:
- GTAA1C, utilizing routine glycemic variability markers, is a valid and practical alternative for defining partial remission in pediatric T1D.
- This formula simplifies assessment and may alleviate confounding factors from insulin treatment.
- GTAA1C offers a promising tool for objective T1D management and research.
Abstract:
Although different criteria were used to define partial remission in type 1 diabetes, the IDAA1C formula has prevailed as it correlates with stimulated C-peptide levels. Our retrospective study evaluated clinical variables associated with the occurrence of IDAA1C-defined partial remission in a series of 239 pediatric patients. Diabetic ketoacidosis and age at diagnosis, but no other clinical feature, influenced the occurrence of remission. We then evaluated whether parameters of glycemic variability used in clinical routine may reliably define partial remission, as these would alleviate confounding factors related to insulin treatment. Using multiple linear regression, we observed that HbA1C levels and percentage of normoglycemia were efficient and sufficient to predict partial remission. These parameters were entered into a formula, called glycemic target-adjusted HbA1C (GTAA1C), that corresponded to HbA1C(%) - (3 × % of normoglycemic values(70-180 mg/dL)). With a threshold of 4.5, this alternative formula predicted partial remission with a sensitivity and a specificity of 72.3% and 92%, respectively, and yielded strong correlation with IDAA1C levels and BETA-2 score, which is a correlate of β-cell function after islet transplantation. We propose GTAA1C, based on routine and objective markers of glycemic variability, as a valid alternative for definition of partial remission in type 1 diabetes.
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