ESPE Abstracts

Background: Type 1 Diabetes (T1D) is a chronic condition characterized by the autoimmune destruction of pancreatic beta cells, leading to insulin deficiency. The honeymoon phase (HP), a period of partial clinical remission shortly after the diagnosis, presents a significant opportunity for intervention. Understanding the factors influencing the duration and onset of HP could inform treatment strategies and potentially prolong the remission period.

Methods: This prospective, single-center study included patients aged 1-18 years newly diagnosed with T1D and positive for at least one diabetes-related autoantibody (ICA, IAA, anti-GAD, ZnT8) between 2022 and 2024. We collected comprehensive demographic, clinical, and laboratory data at diagnosis and evaluated the association between the HP duration and putatively influential factors, including family history of T1D, clinical data, diabetes- related autoantibody levels, and biochemical findings at presentation. The HP was diagnosed with reduction of total daily insulin need to < 0.5 U/kg/d. For an effect size of d=0,15 P = 0,62, 46 patients were deemed sufficient with a power(β) of 95 %. Statistical significance was granted for a p value less than 0.05.

Results: Forty-six (23 female) consecuıtive pediatric patients with T1D at a median age of 9.9 yr [range 1.2-17.3 yr]) were enrolled. Median time to reach HP was 20,5 mo (range:14-28 day). At current evaluation, 10 (21 %) patients were not in HP, with a duration of HP 31 mo (range: 11,8-54,5 day). Among the factors tested, the presence of tissue transglutaminase(tTG) antibody (Ig G or IgA) was strongly correlated with the duration of HP (r_s=+0.756, P = 0.030). Regression analysis showed that family history of T1D, autoantibody (both tTG and diabetes-related antibodies) posititivity, venous blood pH and HCO3 at admission, body mass index, gender and pubertal status had no siginicant association with the duration of HP (P >0.05 in all models).

Conclusion: Our findings suggest that the timing and duration of HP are not associated with the initial presentation findings of the patients with T1D. The strong correlation of the tTG positivity with the duration of HP in our patients may warrant further investigation.

Keywords: Honeymoon, diabetes, autoimmune, tissue transglutaminase antibody