Preliminary data from our group indicated that cyclosporin A induced frequent remissions of insulin dependency in a group of 40 insulin-dependent (type I) diabetic children if given at the onset of clinical manifestations of diabetes. We report a 2-yr analysis of the response to cyclosporin A in the group of 81 patients included in the initial study. As observed before, a remission could be obtained in most of the patients (65%) in association with a shorter duration of symptoms, less severe hyperglycemia, lower incidence of ketoacidosis, and higher plasma C-peptide concentrations. All remissions ended during the follow-up period after a mean ± SE duration of 316 ± 21 days (range 31–850 days). Two parameters were linked to the duration of remissions: the mean circulating level of cyclosporin during the first 3 mo and the duration of prediagnostic polyuria. We were unable to relate the end of a remission to variations in the cyclosporin regimen, titer of autoantibodies, or progression of β-cell failure. The euglycemic clamp technique revealed that insulin sensitivity decreases with time in patients not taking insulin. At 24 mo, the patients who had a remission of insulin dependency had better glycemic control, lower insulin dosages, and C-peptide levels two- to threefold higher than the nonremission patients and four- to sixfold higher than the historical control subjects. The cyclosporin regimen was well tolerated over the observed period: more specifically, serum creatinine remained unchanged, and kidney biopsies performed at 18–24 mo of treatment were within normal limits. We conclude that this immunosuppressive regimen given to patients with overt type I diabetes maintains a residual insulin secretion, which, however, does not allow >2-yr remissions of insulin dependency. It remains to be studied whether some preservation of β-cell function will thereafter be retained and whether this can improve the management and prognosis of the disease. It will also be necessary to test whether earlier diagnosis can ameliorate and prolong our results.
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Original Articles|
October 01 1990
Limited Duration of Remission of Insulin Dependency in Children With Recent Overt Type I Diabetes Treated With Low-Dose Cyclosporin
Pierre-François Bougnères;
Pierre-François Bougnères
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Paul Landais;
Paul Landais
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Catherine Boisson;
Catherine Boisson
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Jean-Claude Carel;
Jean-Claude Carel
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Nathalie Frament;
Nathalie Frament
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Christian Boitard;
Christian Boitard
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Jean-Louis Chaussain;
Jean-Louis Chaussain
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Jean-François Bach
Jean-François Bach
Pediatric Endocrinology and Diabetes Division, Saint Vincent de Paul Hospital, and the Department of Biostatistics and the Clinical Immunology Laboratory, Necker Hospital
Paris, France
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Address correspondence and reprint requests to Dr. P.-F. Bougnères, Saint Vincent de Paul Hopital, 74 Avenue Denfert-Rochereau, 7514 Paris, France.
Diabetes 1990;39(10):1264–1272
Article history
Received:
July 18 1989
Revision Received:
May 14 1990
Accepted:
May 14 1990
PubMed:
2210078
Citation
Pierre-François Bougnères, Paul Landais, Catherine Boisson, Jean-Claude Carel, Nathalie Frament, Christian Boitard, Jean-Louis Chaussain, Jean-François Bach; Limited Duration of Remission of Insulin Dependency in Children With Recent Overt Type I Diabetes Treated With Low-Dose Cyclosporin. Diabetes 1 October 1990; 39 (10): 1264–1272. https://doi.org/10.2337/diab.39.10.1264
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