Rapid Weight Gain After Type 1 Diabetes Diagnosis May Impact Remission Status

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Rapid weight gain in the early stage of intensive insulin therapy after diagnosis of type 1 diabetes (T1D) may play a role in non-remission and shorter duration of partial remission, according to new research.¹

The analysis of nearly 100 children with new-onset T1D suggests the association between weight gain and lack of remission may be due to alterations in insulin sensitivity, indicating the benefit of early weight interventions.

“Interventions to prevent rapid weight gain and conserve insulin sensitivity in the early stages of T1D may be beneficial for the development and maintenance of remission,” wrote the investigative team, led by Dicle Canoruc Emet, department of pediatrics, division of pediatric endocrinology, Hacettepe University Faculty of Medicine.

Recovery of residual beta-cell function and improvement in insulin sensitivity by the reversal of glucose toxicity are phenomena believed to be related to partial remission.² The primary determinant of insulin resistance is body fat content, measured indirectly by body mass index (BMI). Significant increases in BMI are often observed in patients with newly diagnosed T1D in the first few months of insulin therapy, concurrent with the emergence of remission.

As a result, early and significant weight gain after intensive insulin therapy could lead to resistance and impact the occurrence of remission. Emet and colleagues aimed to examine the relationship between early change in body mass index (BMI) standard deviation score and the development and duration of remission in children and adolescents with newly diagnosed T1D.

The study participants consisted of 2- to 16-year-old children with T1D, who had been diagnosed between January 2016 to December 2020. Investigators retrospectively reviewed follow-up records for 1 year after diagnosis.

Insulin dose-adjusted hemoglobin A1c (IDAA1c) values were calculated for each participant at each visit. Patients were separated into remitter and non-remitter groups according to IDAA1c value. Laboratory and clinical data, as well as the daily insulin requirement per kilogram of body weight at diagnosis and each visit, were recorded, and investigators determined the duration of partial remission.

For the purpose of analysis, early changes in BMI-standard deviation score (BMI-SDS) were evaluated using auxological parameters at the time of diagnosis and in the outpatient control at the 6th month after diagnosis. A total of 99 children, with a mean age of 8.7 years, were included in the study. Of the population, there were 47 remitters (47.5%) and 52 (52.5%) non-remitters.

The partial remission developed after a mean period of 3.7 months following diagnosis. After diagnosis, BMI-SDS significantly increased in 6 months (P <.01) in the whole group. Investigators noted the mean increase in BMI-SDS was higher in the non-remitter group compared to the remitter group (P = .04).

The mean duration of partial remission was 8.9 months. However, the duration of partial remission was not correlated to clinical parameters, including age, sex, puberty status, and BMI-SDS, or laboratory parameters at diagnosis, including blood glucose, insulin, and HbA1c. Investigators found no significant correlation between the duration of remission and BMI-SDS between 6 and 12 months after diagnosis.

Multivariate regression revealed prepubertal status, male sex, younger age, and lower HbA1c at the time of diagnosis as positive predictors of partial remission. However, after adjustment, the only independent factor linked to the development of partial remission was male sex.

“This is the first study, as far as we have investigated the English literature, that shows the significant association between early weight gain after diagnosis and remission phase,” investigators wrote. “Therefore, a prospective study with a large number of cases is expected to address this issue in more detail.”

References

1. Emet DC, Karavar HN, Gozmen O, et al. Early weight gain after diagnosis may have an impact on remission status in children with new-onset type 1 diabetes mellitus [published online ahead of print, 2023 Aug 12]. J Diabetes. 2023;10.1111/1753-0407.13455. doi:10.1111/1753-0407.13455
2. Zhong T, Tang R, Gong S, Li J, Li X, Zhou Z. The remission phase in type 1 diabetes: changing epidemiology, definitions, and emerging immuno-metabolic mechanisms. Diabetes Metab Res Rev. 2020; 36(2):e3207