SAT-219 - Spontaneous Resolution Of Autoimmune Type 1 Diabetes In An Adolescent Three Years After Diagnosis

Background: Complete remission of Type 1 Diabetes (T1D), characterized by sustained insulin independence, is infrequent among children and adolescents, especially when persistent islet autoantibodies are present. Most patients experience only a temporary partial remission, known as the honeymoon phase, within the first year following diagnosis, with remission rates diminishing rapidly thereafter.{1-4}

Case Report: We present the case of an adolescent male diagnosed with Type 1 Diabetes Mellitus (T1DM), who initially presented in 2021 with classic symptoms of diabetes. His c-peptide was low at 1.9 ng/mL and had positive GAD65 and IA-2 autoantibodies. Three years later, in January 2024, the patient experienced significant weight loss, accompanied by abdominal pain and nausea. He also admitted substance abuse at that time. A comprehensive gastrointestinal evaluation, including endoscopy, colonoscopy, and biopsies, yielded unremarkable results. The patient ceased using his insulin pump in November 2024 and discontinued all basal and bolus insulin by May 2025, resorting to rapid-acting insulin only occasionally for isolated instances of elevated glucose levels. Despite the complete cessation of basal and bolus insulin, blood glucose readings remained stable (90-120 mg/dL), and his HbA1c levels increased only marginally from 5.3% to 5.8%. Autoantibody titers for GAD65, insulin autoantibodies, and ZNT8 remained persistently positive throughout the follow-up period. His c-peptide level dropped to 1.5 ng/mL. He stopped losing weight after the cessation of substance abuse. His weight gain improved following dietary modifications. He has not experienced any episodes of diabetic ketoacidosis during this period of insulin independence.

Discussion: Complete remission in pediatric T1D is observed in only 2–3% of cases, typically of short duration and infrequently associated with persistent autoantibody positivity.{1,5} Factors that favor remission include an older age at onset and higher residual c-peptide levels; however, ongoing autoimmunity generally predicts a rapid decline in beta-cell function.{1,3,5} This case challenges existing paradigms, suggesting that rare individuals may sustain endogenous insulin secretion despite persistent autoimmunity. The mechanisms underlying such prolonged remission remain unclear but may involve unique immunometabolic or genetic factors.{2,6}

Conclusions: This case presents a remarkable instance of sustained, complete insulin independence in an auto-antibody-positive adolescent with Type 1 Diabetes. Further investigation of such outliers may yield valuable insights into beta-cell preservation and inform future therapeutic strategies.

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