ESPE Abstracts

Background: The exact mechanism of the partial clinical remission in type 1 diabetes mellitus (T1DM) has not been elucidated yet. The severity of the inflammation at the time of diagnosis may have an impact on the occurrence or duration of this phase.

Objective: We aimed to investigate the relationship between hematological inflammatory parameters at the time of diagnosis in children and adolescents with T1DM and the need for insulin during the first year of the follow-up and the presence of partial clinical remission period as determined according to insulin dose-adjusted HbA1c levels.

Subjects and methods: A single-center retrospective study was conducted, including patients aged 1-18 years who were diagnosed with T1DM in a tertiary center between 2010-2020. Patients with any concomitant acute or chronic diseases and infections at the time of diagnosis were excluded.

Results: Sixty-eight patients (55.9% female, 64.7% prepubertal) were included in the study, whose mean age was 8.4 ± 4.2 years. A total of 38 patients (55.9%) had partial clinical remission. Serum insulin and C-peptide levels at the time of diagnosis were significantly higher in remitters than non-remitters (P = 0.026 and P = 0.004, respectively). Initial neutrophil/lymphocyte ratio (NLR) and derived-NLR (d-NLR) levels were significantly lower (P = 0.011 and P = 0.033, respectively) and lymphocyte/monocyte ratio (LMR) levels significantly higher (P = 0.005) in patients who showed an insulin requirement of <0.5 IU/kg/day at the 3^rd month after diagnosis. The sensitivity of a cut-off NLR value of 1.64 was 69.2% and the specificity was 59.5%, whereas these were found as 69.2% and 54.8% for the best threshold value (1.17) of d-NLR, respectively. An LMR of 4.71 was found to be the best cut-off value for estimating a low daily insulin requirement on the 3^rd month after diagnosis (sensitivity; 66.7%, specificity; 61.5%).

Conclusions: We showed that a lower NLR and d-NLR, or a higher LMR at the time of diagnosis can be used as a predictor for a low need of daily insulin at the 3^rd month of T1DM, for the first time in literature.