Spontaneous complete remission of type 1 diabetes mellitus in an adult
Updated: Oct 22, 2018
This is an interesting case report published by my team in the Journal of Community Hospital Internal Medicine Perspectives.
Type 1 diabetes mellitus (T1DM) is an autoimmune condition that results in low plasma insulin levels by destruction of beta cells of the pancreas. As part of the natural progression of this disease, some patients regain beta cell activity transiently. This period is often referred to as the 'honeymoon period' or remission of T1DM.
Authors of this articles in the original order: Harsha Moole, MD,* Vishnu Moole, MBBS, Adrija Mamidipalli, MBBS, Sowmya Dharmapuri, MBBS, Raghuveer Boddireddy, MBBS, Deepak Taneja, MD, Hady Sfeir, MD, and Sonia Gajula, MD.
During this period, patients manifest improved glycemic control with reduced or no use of insulin or anti-diabetic medications. The incidence rates of remission and duration of remission is extremely variable. Various factors seem to influence the remission rates and duration. These include but are not limited to C-peptide level, serum bicarbonate level at the time of diagnosis, duration of T1DM symptoms, haemoglobin A1C (HbA1C) levels at the time of diagnosis, sex, and age of the patient.
Access full article at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612476/.
Mechanism of remission is not clearly understood. Extensive research is ongoing in regard to the possible prevention and reversal of T1DM. However, most of the studies that showed positive results were small and uncontrolled.
We present a 32-year-old newly diagnosed T1DM patient who presented with diabetic ketoacidosis (DKA) and HbA1C of 12.7%. She was on basal bolus insulin regimen for the first 4 months after diagnosis. Later, she stopped taking insulin and other anti-diabetic medications due to compliance and logistical issues. Eleven months after diagnosis, her HbA1C spontaneously improved to 5.6%. Currently (14 months after T1DM diagnosis), she is still in complete remission, not requiring insulin therapy.
*Update: After approximately 18 months of remission, she was started back on medications to manage her hyperglycemia.