Clinical remission of type 1 diabetes

Abstract

In natural history of type 1 diabetes gradual reduction of β-cell mass proceed during several years. Clinically symptoms of diabetes develop when β-cell mass reach state in which insulin secretion will be insuffi cient tokeep glycaemia in normal range. Diabetes occurs when 80–90% of islet cells will be destroyed. Pathogenesis of autoimmune destruction of β-cell is not fully understood. It includes interaction between genetic, environmental factors and appearing autoantibodies. Soon after diagnosis of type 1 diabetes and introducing insulin therapy reduction of exogenous insulin requirement is observed. This phenomenon is called clinical remission. Because of the ambiguous diagnostic criteria, identifying and comparing the frequency of occurrence of remission in type 1 diabetes is diffi cult. Despite of difference in remission criteria, they all underline residual insulin secretion. Most of remission criteria take into account following parameters: glycated hemoglobin value, daily exogenous insulin requirement and C-peptide serum level. Occurrence of remission is extremely desirable in type 1 diabetes. It influences positively on metabolic control of diabetes, reduces the risk of hypoglycaemia, improves quality of life and probably infl uence on development of chronic complications. This paper summarizes the current state of knowledge in the fi eld of clinical remission of type 1 diabetes.