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Benjamin Nwosu confirms accuracy of simple method to detect honeymoon period in children newly diagnosed with type 1 diabetes

Pediatric diabetes expert urges use of easily calculated measure to monitor partial clinical remission

By Sandra Gray

UMass Medical School Communications

September 19, 2017
  Benjamin Nwosu, MD
 

Benjamin Nwosu, MD

Children who are newly diagnosed with type 1 diabetes and begin to receive treatment may experience a partial clinical remission, sometimes referred to as a “honeymoon period,” during which they are still secreting some insulin on their own and their blood glucose levels can temporarily be restored to at or near normal levels. Patients who do not undergo this honeymoon may experience worse outcomes over the long term, so it is important to determine if this partial remission is present or not.

A study conducted by UMass Medical School physician-scientist Benjamin Nwosu, MD, has confirmed the accuracy of a new, simple method to determine whether children newly diagnosed with type 1 diabetes are experiencing this beneficial partial clinical remission.

The study, published recently in the Journal of Pediatric Endocrinology and Metabolism, compared two methods. Called IDAA1C, the calculation that correlates daily insulin doses with average blood glucose levels has been considered the gold standard; a measure of less than 9 percent indicates that a patient is in partial clinical remission.

Investigators tested whether a total daily dose (TDD) of insulin—a measure needed to make the more complex IDAA1C calculation—of less than 0.3 units per kilogram of body weight per day, on its own indicates that remission is underway. The comparison showed no significant differences in the number of remitters, duration of remission or the time of peak remission defined by either method.

“There has been no consensus on a simple and easily usable tool for the detection and monitoring of partial clinical remission. Although the components are readily accessible, calculating the IDAA1C may represent a barrier to time-strapped clinicians, preventing its widespread use,” said Dr. Nwosu, associate professor of pediatrics. “The calculation of TDD is already being performed by endocrinologists during routine clinic visits. Therefore, in a busy outpatient clinic, it may serve as a more practical tool for early detection and monitoring of the honeymoon period.”

Patients who experience the honeymoon period are able to make some of their own insulin, and their blood glucose levels can be restored to at or near normal levels for a period lasting from three months to a year after treatment begins. Patients newly diagnosed with type 1 diabetes who do not experience partial clinical remission require higher doses of insulin over the long term and are more likely to suffer from serious diabetes-related complications, including blindness and cardiovascular problems later in life.

Previous research by Dr. Nwosu found that more than 50 percent of children and adolescents with new-onset T1D do not experience PCR, underscoring the importance of close monitoring and management of glucose levels immediately following diagnosis. Confirming that the easier monitoring method is as reliable as the gold standard can help those treating children with type 1 diabetes more easily go from diagnosis to clinical follow up for the majority of patients who do not benefit from the honeymoon period. 

“Encouraging clinicians to use the total daily dose of insulin guideline will improve monitoring of PCR and, therefore, ensure the prevention of early hyperglycemia in patients who exceed it for better long term outcomes,” Nwosu concluded.

Related story on UMassMedNow:
Predictive tool for children with type 1 diabetes will improve care, avoid complications

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