The early partial remission of juvenilediabetes mellitus: The roles of insulin and growth hormone

doi:10.1016/S0022-3476(67)80007-6

The Journal of Pediatrics

Volume 71, Issue 6, December 1967, Pages 825-831

https://doi.org/10.1016/S0022-3476(67)80007-6 Get rights and content

Ten children with juvenile diabetes mellitus were studied with oral glucose tolerancetests at the onset of their disease and during the period of partial remission. No significant improvement in carbohydrate tolerance was observed. Free fatty-acid responses improved, but abnormalities were still demonstrable. Fasting growth hormone levels were normal, and no changes were noted in the growth-hormone responses before therapy and during remission. Plasma insulin concentrations were very low at the time of the clinical onset, and no significant improvement in insulin secretion was observed during the phase of partial remission. These data suggest that increased insulin production or changes in growth hormone do not play roles in the early partial remission of juvenile diabetes.

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Cited by (38)

Preventive interventions for type 1 diabetes: History, appraisal and prospects
2007, Canadian Journal of Diabetes
Citation Excerpt :
Clinical experience with insulin yielded the first indication that the process leading to type 1 diabetes might respond to treatment. This perception arose from the recognition of "partial remission" in recent-onset type 1 diabetes, manifested as a decline in the daily insulin dose to a minimum at about 3 months after diagnosis, under clinical conditions (1). Much later, studies of continuing endogenous secretion of insulin, and of "sensitivity" to exogenous insulin, revealed mechanistic features of these remissions (2).
Putative therapeutic interventions with hypothetical clinical benefit in overt type 1 diabetes, or in the pre-clinical condition with evidence of the active autoimmune process, or in people at risk for the disease by virtue of family history with or without genotypic evidence of increased risk, have now been undertaken.These are summarized and appraised in this narrative review, which deals in historical order, the Diabetes Control and Complications Trial (DCCT) and its epidemiological follow-up, the Canadian-European Randomized Trial of Cyclosporin in Recent-Onset Type 1 Diabetes (CERT), the Diabetes Prevention Trial Type 1 (DPT1), the European Nicotinamide Diabetes Intervention Trial and its Canadian component (ENDIT-CANENDIT), and the Trial to Reduce Insulin-Dependent Diabetes in the Genetically at Risk (TRIGR) now in progress in Europe, North America and Australia. It is suggested that the experience justifies continuing exploration of potential clinical interventions, in each stage of the history of autoimmune type 1 diabetes. It is emphasized that this endeavour mandates long-term followup, with assessment of outcomes, to be compared with those of contemporary standard of care management of the disease. In discussion, potential novel interventions are considered, and it is concluded that it is reasonable to expect that these studies will eventually yield results providing platforms for the development of preventive or curative treatments for type 1 diabetes.
Des interventions thérapeutiques ayant des bienfaits cliniques hypothétiques sur le diabète de type 1 avéré, sur l'état préclinique associé à l'activité du processus auto-immun ou chez des personnes exposées à la maladie en raison d'antécédents familiaux, que des preuves génotypiques d'un risque accru soient présentes ou non, sont maintenant utilisées. Ces interventions sont résumées et évaluées dans cette analyse narrative qui constitue un survol historique de l'essai DCCT (Diabetes Control and Complications Trial) et de son suivi épidémiologique, de l'essai CERT (Canadian-European Randomized Trial of Cyclosporin in Recent-Onset Type 1 Diabetes), de l'essai DPT1 (Diabetes Prevention Trial Type 1), de l'essai ENDIT-CANENDIT (European Nicotinamide Diabetes Intervention Trial et son volet canadien) et de l'essai TRIGR (Trial to Reduce Insulin-Dependent Diabetes in the Genetically at Risk) maintenant en cours en Europe, en Amérique du Nord et en Australie. On avance que l'expérience justifie la poursuite de l'exploration d'interventions cliniques possibles à chaque stade de l'évolution du diabète auto-immun de type 1. On appuie sur le fait que cette exploration exige un suivi à long terme, au cours duquel on évalue les résultats et les compare à ceux des normes contemporaines en matière de gestion de la maladie. On évalue des interventions novatrices possibles et conclut qu'il est raisonnable de s'attendre à ce que ces études donnent un jour des résultats qui serviront d'assise au développement de traitements préventifs et curatifs du diabète de type 1.
Effect of l-dihydroxyphenylalanine upon serum growth hormone concentrations in children and adolescents
1972, The Journal of Pediatrics
Serum growth hormone levels were measured serially in 26 children and adolescents, two adult males, and four patients with Parkinson's disease after oral administration of 0.5 Gm. of l-dihydroxyphenylalanine (l-dopa); the results were compared to those obtained after administration of arginine and insulin. In 22 children without pituitary disease the mean maximum growth hormone concentration (8.9±1.5 [S.E.M.] mμg per milliliter) was recorded 60 minutes after l-dopa ingestion. The mean peak growth hormone concentrations was 11.2±1.4 mμg per milliliter; the mean increment was 10.1±1.4 mμg per milliliter. During a combined arginine-insulin tolerance test (N=19) the mean peak growth hormone value was 13.4±1.3 mμg per milliliter; the mean increment was 11.9±1.2 mμg per milliliter. Growth hormone levels did not increase in four patients with hypopituitarism following administration of l-dopa, arginine, or insulin. Growth hormone concentrations increased in both adult males and in one of four patients with Parkinson's disease after administration of l-dopa. Variable changes in blood glucose and insulin concentrations followed l-dopa ingestion. l-dopa stimulates the release of growth hormone in young subjects without pituitary disease.
Factors associated with early beginning of partial remission in young adult patients with newly diagnosed type 1 diabetes
2015, International Journal of Diabetes in Developing Countries
Early markers of glycaemic control in children with type 1 diabetes mellitus
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Type 1 diabetes: Etiology, immunology, and therapeutic strategies
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^*: Supported in part by United States PublicHealth Service Grants HD-00444, AM-00619-09 (HD 00371-14), and TGMD (ST)-1AM-05197-08. Part of these studies were carried out in the Clinical Research Center of the Children's Hospital of Philadelphia, supported by Grant FR00240, United States Public Health Service, Division of Research Facilities and Resources.

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Original articleThe early partial remission of juvenilediabetes mellitus: The roles of insulin and growth hormone*

J. Lipid Res.

Determination of glucose by an improved “Glucostat” procedure

Clin. Chem.

The colorimetric microdetermination of long-chain fatty acids

Biochem. J.

Immunoassay of plasma insulin

Methods Biochem. Analysis

A sensitive double antibody immunoassay for human growth hormone in plasma

Nature (London)

The plasma-growth-hormone response to insulin-induced hypoglycemia in children with retardation of growth

Pediatrics

Studies on serum insulin-like activity (ILA) in prediabetes and early overt diabetes

Diabetes

Bestimmung der Insulinaktivitat im Serum Unbehandelter Jugendlicher Diabetiker nach Glukosebelastung

Acta Endocrinologica

Original article
The early partial remission of juvenilediabetes mellitus: The roles of insulin and growth hormone*