Clinical and immunological factors influencing the onset and course of partial remission in pediatric type 1 diabetes

Purpose: This study examined key clinical and immunological factors influencing the onset and course of partial remission (PR) in children and adolescents with newly diagnosed type 1 diabetes(T1D). Materials and Methods: A total of 201 pediatric patients with T1D were enrolled. PR was defined as an insulin dose-adjusted HbA1c(IDAA1c) of≤9. Participants were categorized into two groups: PR and NR (non-remission). Results: Partial remission occurred in 138 (69%) patients. In the PR group, the mean age at diagnosis was 9.4 ± 3.8 years, with PR onset occurring 1.6 ± 1.4 months after diagnosis and lasting for a mean duration of 7.3 ± 5.2 months. Overweight/obesity was strongly associated with PR, as 81% of overweight/obese patients achieved remission. Anti-glutamic acid decarboxylase (anti-GAD) antibody positivity was more frequent in the PR group (63.0% vs. 33.3%). Longer remission was seen in patients with puberty, overweight/obesity, or coeliac disease, whereas positivity for anti-GAD and islet cell antibodies was associated with shorter remission. Conclusion: Anti-GAD and ICA antibodies have distinct effects on PR, reflecting the complexity of autoimmune activity in pediatric T1D. The presence of obesity, puberty, and celiac disorder supports the need for a immuno-metabolic strategy for the early prediction and management of PR in pediatric T1D.