AGE GOVERNS GENDER-DEPENDENT ISLET-CELL AUTOREACTIVITY AND PREDICTS THE CLINICAL COURSE IN CHILDHOOD IDDM

Most IDDM patients temporarily restore some of their beta-cell functio n following the initiation of insulin therapy. The aim of this study w as to analyse the influence of age, gender, metabolic state at diagnos is and presence of autoantibodies (GAD65 antibodies and ICA) on the du ration of the clinical partial remission. In total, 149 consecutively diagnosed IDDM children, 0-16 y old (70F, 79M, mean age 9.5 y) were st udied. partial remission was arbitrarily defined as the period when th e insulin dose was below 0.5 U/BW 24 h(-1) and HbA1c below 7.5%, and o ccurred in 119/149 patients with a duration between 1 and 38 months. C ox's regression analysis showed that the factors significantly associa ted with the duration of remission were age, gender, interaction betwe en age and gender, ICA and a high initial HbA1c, whereas GAD65Ab had n o influence. Young boys had the shortest remission period, while adole scent boys had the longest, as compared to young and adolescent girls. The ICA-negative patients (n = 42) had a longer remission period (med ian 9.7 months) than the ICA-positive children (n = 107; 5.0 months; p = 0.0001), regardless of GAD65Ab status. We speculate that the relati ve insulin resistance, which is more pronounced in pubertal girls than in boys, may be associated with a more rapid increase of exogenous in sulin requirement. These findings are important when evaluating the ef fect of islet cell autoreactivity on the clinical course of IDDM in ch ildren.