7 YEARS OF REMISSION IN A TYPE-I DIABETIC PATIENT

OBJECTIVE - To analyze factors contributing to a long-term remission i n a patient with type I diabetes. RESEARCH DESIGN AND METHODS - The pa tient was treated with cyclosporin for 16 mo after a short duration of symptoms. During the 7-yr follow-up, we tracked his glycemic control, oral glucose tolerance, insulin sensitivity, endogenous insulin secre tion, and beta-cell immunology. The results are compared with those of matched diabetic patients and healthy control subjects. RESULTS - Ins ulin therapy was discontinued after 5 wk. Thereafter the patient had n ormal fasting and home blood glucose concentrations and near-normal Hb A1c without insulin therapy for 7 yr. During this period, he maintaine d islet cell antibodies, although his basal and glucagon-stimulated C- peptide concentrations were normal. He participated in active physical training and had an insulin sensitivity higher than in sedentary cont rol subjects or trained diabetic patients and equal to that in healthy athletes. His oral glucose tolerance decreased gradually and became d iabetic during the last 3 yr. CONCLUSIONS - In this patient, an early start of cyclosporin therapy probably contributed To the maintenance o f endogenous insulin secretion, and insulin sensitivity was high becau se of physical training. Consequently, the patient was able to maintai n normoglycemia without exogenous insulin therapy for 7 yr.