Residual beta-Cell Function 3-6 Years After Onset of Type 1 Diabetes Reduces Risk of Severe Hypoglycemia in Children and Adolescents

摘要

OBJECTIVETo determine the prevalence of residual -cell function (RBF) in children after 3-6 years of type 1 diabetes, and to examine the association between RBF and incidence of severe hypoglycemia, glycemic control, and insulin requirements.RESEARCH DESIGN AND METHODSA total of 342 children (173 boys) 4.8-18.9 years of age with type 1 diabetes for 3-6 years were included. RBF was assessed by testing meal-stimulated C-peptide concentrations. Information regarding severe hypoglycemia within the past year, current HbA(1c), and daily insulin requirements was retrieved from the medical records and through patient interviews.RESULTSNinety-two children (27%) had RBF 0.04 nmol/L. Patients with RBF 0.04 nmol/L (odds ratio, 2.59; 95% CI, 1.10-7.08; P 0.03). HbA(1c) was significantly higher in patients with RBF 0.04 nmol/L (mean, 8.49 0.08% [69.3 +/- 0.9 mmol/mol] vs. 7.92 +/- 0.13% [63.1 +/- 1.4 mmol/mol]; P 0.01), and insulin requirements were significantly lower in patients with RBF 0.2 nmol/L (mean +/- SE: 1.07 +/- 0.02 vs. 0.93 +/- 0.07 units/kg/day; P 0.04).CONCLUSIONSWe demonstrated considerable phenotypic diversity in RBF among children after 3-6 years of type 1 diabetes. Children with RBF are at lower risk for severe hypoglycemia, have better diabetes regulation, and have lower insulin requirements compared with children without RBF. There appears to be a lower limit for stimulated RBF of approximate to 0.04 nmol/L that confers a beneficial effect on hypoglycemia and metabolic control.