Mittal M, Porchezhian P, Kapoor N. Honeymoon phase in type 1 diabetes mellitus: A window of opportunity for diabetes reversal? World J Clin Cases 2024; 12(1): 9-14 [PMID: 38292619 DOI: 10.12998/wjcc.v12.i1.9]
Corresponding Author of This Article
Madhukar Mittal, FACE, MD, Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Basni Phase 2, Jodhpur 342005, India. mittalspace@gmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Madhukar Mittal, Pradakshna Porchezhian, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Jodhpur 342005, India
Nitin Kapoor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore 632004, Tamil Nadu, India
Author contributions: Mittal M conceptualized the manuscript; Porchezhian P and Mittal M wrote the manuscript; Kapoor N provided critical inputs in writing the paper; all authors reviewed and approved the final manuscript.
Conflict-of-interest statement: All the authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Madhukar Mittal, FACE, MD, Professor, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences Jodhpur, Basni Phase 2, Jodhpur 342005, India. mittalspace@gmail.com
Received: October 29, 2023 Peer-review started: October 29, 2023 First decision: November 28, 2023 Revised: December 8, 2023 Accepted: December 14, 2023 Article in press: December 14, 2023 Published online: January 6, 2024
Abstract
The knowledge of the pathogenesis of type 1 diabetes mellitus (T1DM) continues to rapidly evolve. The natural course of the disease can be described in four clinical stages based on the autoimmune markers and glycemic status. Not all individuals of T1DM progress in that specific sequence. We hereby present a case of T1DM with a classical third phase (honeymoon phase) and discuss the intricacies of this interesting phase along with a possible future promise of “cure” with the use of immunotherapies. We now know that the course of T1DM may not be in only one direction towards further progression; rather the disease may have a waxing and waning course with even reversal of type 1 diabetes concept being discussed. The third phase popularly called the “honeymoon phase”, is of special interest as this phase is complex in its pathogenesis. The honeymoon phase of T1DM seems to provide the best window of opportunity for using targeted therapies using various immunomodulatory agents leading to the possibility of achieving the elusive “diabetes reversal” in T1DM. Identifying this phase is therefore the key, with a lot of varying criteria having been proposed.
Core Tip: The insulin requirement reduces drastically in the Honeymoon phase or the partial remission phase in type 1 diabetes mellitus (T1DM). Novel pharmacological interventions and immunomodulating therapies in T1DM are being tried specifically in this phase as it may serve as the potential window of opportunity for possible “cure”. It may therefore be clinically relevant to timely identify this phase in these patients.
