A Common Tool for Measuring Type 1 Diabetes Remission May Miss the Mark in Some Young People

In Type 1 diabetes, partial remission refers to a period when the pancreas still produces some of its own insulin. Doctors and researchers use this measurement to track disease progression and to determine who qualifies for clinical trials testing new therapies.

A formula called IDAA1c has become the standard tool for identifying partial remission in young people. It combines hemoglobin A1c (a measure of average blood sugar over three months) with the amount of insulin a person injects daily. The formula is simple: if IDAA1c is 9 or lower, a person is considered to be in partial remission.

This measure is so widely used that it appears in the design of major clinical trials testing disease-modifying therapies for Type 1 diabetes. However, until now, this formula had never been rigorously tested in a large U.S. population of young people with Type 1 diabetes.

Researchers from the SEARCH for Diabetes in Youth study examined data from 422 young people diagnosed with Type 1 diabetes. They compared what the IDAA1c formula predicted against a more direct measurement of beta cell function—C-peptide stimulated by a mixed-meal tolerance test. C-peptide is a substance the pancreas releases when it produces insulin, making it a reliable indicator of how much insulin the pancreas is still making.

The researchers divided participants into two groups based on body weight: those with normal or low weight, and those with overweight or obesity. This allowed them to see whether the formula worked equally well across different body types.

Overall, the IDAA1c ≤9 formula correctly identified partial remission about 61% of the time. This means roughly 4 out of 10 young people who were actually in partial remission would be missed by this cutoff.

The results were even more concerning in young people with overweight or obesity. In this group, the formula only caught 45% of those in actual remission—meaning more than half would be incorrectly classified as not being in remission.

Interestingly, young people with higher body weight had lower IDAA1c scores on average, even though their pancreases were producing more insulin. This happened because they needed larger daily insulin doses to manage their blood sugar, which inflated their IDAA1c calculation and masked their actual beta cell function.

These findings suggest that the current definition of partial remission may not work fairly across all young people with Type 1 diabetes. Young people with overweight or obesity could be unfairly excluded from clinical trials or incorrectly assessed as not being in remission, even when their pancreases are still producing meaningful amounts of insulin.

The study does not provide guidance for individuals or families—that remains a conversation for healthcare teams. However, it does raise important questions for the research community about how remission should be measured going forward, particularly as new disease-modifying therapies are tested and refined.

Source: Diabetes care. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.