Prednisone Treatment in Newly Diagnosed Type I Diabetic Children: 1-Yr Follow-Up

Thirty-one children suffering from type I diabetes mellitus were arranged at onset of the disease in two different groups. Group 1 was treated with oral prednisone (60 mg · m⁻² · day⁻¹ for 14 days, 30 and 15 mg · m⁻² · day⁻¹ for 7 days). Group 2 matched the control group. All patients were treated with continuous subcutaneous insulin infusion for the first 15 days of treatment, and then with two daily injections of a mixture of intermediate- and fast-acting insulin. All subjects were followed for 1 yr. Group 1 required more insulin than group 2 after 30 days (1.5 ± 0.3 vs. 0.6 + 0.2 U · kg⁻¹ · day⁻¹, P < .001) and after 60 days (0.8 ± 0.1 vs. 0.5 ± 0.06 U · kg⁻¹ · day⁻¹, P < .001). After 3 mo, both groups reached the lowest mean stable HbA₁ level (8.4 ± 0.4 and 8.3 ± 0.4% group 1 and 2 respectively). Between the 2nd and 9th mo of follow-up, mean postbreakfast C-peptide concentration increased in both groups. The highest levels of fasting C-peptide were reached by group 1 after 90 days (0.77 ± 0.32 nM) and group 2 after 60 days (0.34 ± 0.09 nM). The largest partial remission (C-peptide 0.3 nM, insulin requirement <0.5 U · kg⁻¹ · day⁻¹ and no glycosuria) was observed in group 1 after 180 days (5 of 16 patients) and in group 2 after 60 days (5 of 15 patients). We found no significant difference between the two groups in fasting and postbreakfast C-peptide levels, stable HbA₁, and remission during 1-yr follow-up. Short-term prednisone therapy in newly diagnosed type I diabetic children does not considerably modify the natural history of the disease during the 1st yr.