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Remission of classical type 1 diabetes after weight loss (#268)

Shanal Kumar 1 , Peter G Colman 1 , Leonard C Harrison 2 , Spiros Fourlanos 1
  1. Dept Diabetes & Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
  2. Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia

We present the case of a female diagnosed with classical type 1 diabetes (T1D) who then had complete disease remission after weight loss. Her family history was significant for T1D in a first-degree relative and she was enrolled in the Melbourne Pre-Diabetes Family Study. At age 6 she was identified to be seropositive for autoantibodies to glutamic acid decarboxylase (GADA) and islet-cell antigen 2 (IA2A) and then participated in a randomised crossover clinical trial of nasal insulin. Anti-islet antibodies were detected on multiple different blood samples. She was eventually diagnosed with T1D at age 21 after presenting to hospital with classical symptoms of polyuria and polydipsia for 1 week in association with hyperglycaemia (plasma glucose 19.4 mmol/L), ketosis and insulin deficiency (fasting C-peptide 0.31 nmol/L). At diagnosis her HbA1c was 12.8% yet GADA and IA2A were undetectable. She was stabilised on basal bolus insulin (0.3units/kg/day) and achieved excellent glycaemia by 2 months (HbA1c 6.6%). Her insulin requirements decreased to 0.14units/kg/day by 8 months, 0.05units/kg/day by 14 months and insulin was ceased 16 months after diagnosis. Following diagnosis, when her BMI was 28kg/m2, lifestyle intervention (regular exercise and fewer carbohydrate portions) led to 9kg weight loss (15% bodyweight) with BMI decreasing to 24kg/m2. The HbA1c remained < 6% over the next 16 months and islet antibodies remained undetectable.

This case demonstrates a highly atypical course of T1D. Firstly, the islet antibodies were not evident at T1D onset. Secondly, remission of T1D occurred after significant lifestyle change and weight loss. Partial remission (PR) of T1D typically can last up to 24 months.1  Residual beta-cell function at onset can influence the frequency and duration of PR.2  Earlier age of diagnosis is associated with shorter periods of PR.3  Physical activity may also influence the PR duration.4  Obesity at diagnosis may be associated with lower genetic risk and slower disease progression.5  Further research is required to determine if weight loss may induce remission of T1D in those presenting overweight at diagnosis in adulthood.

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  5. Fourlanos S, Elkassaby S, Varney MD, Colman PG, Harrison LC. Higher body mass index in adults at diagnosis of type 1 diabetes is associated with lower risk HLA genes. Diab Res Clin Pract. 2014 Jun:104:69-71.