Relapsing/remitting type 1 diabetes

• DOI: 10.1007/s00125-017-4403-3
• Publication Date: 2017-08-23T03:35:11Z
• Authors: Kayleigh M. van M...; Matthew P. Spindler; Fleur M. Keij; Ineke Bosch; Fleur Sprangers; Annet van Royen-K...; Tatjana Nikolic; Bart O. Roep
• Keywords: Blood Glucose; 0301 basic medicine; 0303 health sciences; Immune regulation; Adolescent; Endocrinology, Diabetes and Metabolism; Short Communication; Autoimmunity; 7. Clean energy; 3. Good health; 03 medical and health sciences; Type 1 diabetes; Diabetes Mellitus, Type 1; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; 13. Climate action; Insulin-Secreting Cells; Autoimmune disease; Internal Medicine; Leukocytes, Mononuclear; Humans; Female; Immunotherapy

Type 1 diabetes is believed to be an autoimmune disease associated with irreversible loss of insulin secretory function that follows a chronic progressive course. However, it has been speculated that relapsing/remitting disease progression may occur in type 1 diabetes.We report the case of an 18-year-old girl with Graves' disease, chronic inflammatory demyelinating polyneuropathy (CIDP) and multiple islet autoantibodies, presenting with relapsing/remitting hyperglycaemia. Peripheral blood mononuclear cells were analysed for islet autoimmunity.There were two instances of hyperglycaemia relapse during CIDP flare-ups that required insulin therapy and remitted after i.v. immunoglobulin (IVIG) therapy improving neurological symptoms. A diagnosis of type 1 diabetes was assigned on the basis of insulin need, HbA1c and islet autoantibodies. Insulin requirements disappeared following IVIG treatment and peaked during CIDP flare-ups. Pro- and anti-inflammatory cytokine responses were noted against islet autoantigens.We provide clinical evidence of relapsing/remitting type 1 diabetes associated with IVIG treatment and the regulation of islet autoimmunity. Despite sufficient residual beta cell mass, individuals can experience episodes of impaired glycaemia control. This disconnect between beta cell mass and function highlighted by our case may have implications for the use of beta cell function as the primary endpoint for immune intervention trials aiming to protect beta cell mass rather than function. Immune modulation may restore beta cell function and glycaemic control.