{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:36Z","timestamp":1784557056278,"version":"3.55.0"},"reference-count":30,"publisher":"Bioscientifica","content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,12,21]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by autoimmune destruction of pancreatic beta cells and inadequate insulin production. Remission criteria in T1DM take into account serum levels of C-peptide and glycosylated hemoglobin, as well as the dose of insulin administered to the patient. However, remission of T1DM lasting longer than 1 year is rare. We describe here the cases of two young women who presented with positive glutamic acid decarboxylase (GAD) antibody and classic clinical manifestations of T1DM. Both patients had a prior history of Hashimoto\u2019s thyroiditis. They were initially treated with a basal-bolus regimen of insulin (glargine and lispro\/glulisine). Once their blood glucose levels were controlled, they were started on oral sitagliptin 100\u2009mg and vitamin D3 5000\u2009IU daily. After this therapy, both patients achieved clinical diabetes remission for 4 years, along with a decrease in anti-GAD antibody levels. These benefits were probably associated with immunological effects of these medications. Inhibition of dipeptidyl peptidase 4 (DPP-4) in animal models deregulates Th1 immune response, increases secretion of Th2 cytokines, activates CD4\n                    <jats:sup>+<\/jats:sup>\n                    CD25\n                    <jats:sup>+<\/jats:sup>\n                    FoxP3\n                    <jats:sup>+<\/jats:sup>\n                    regulatory T-cells and prevents IL-17 production. Vitamin D3 also activates CD4\n                    <jats:sup>+<\/jats:sup>\n                    CD25\n                    <jats:sup>+<\/jats:sup>\n                    FoxP3\n                    <jats:sup>+<\/jats:sup>\n                    regulatory T-cells, and these medications combined can improve the immune response in patients with new-onset T1DM and probably promote sustained clinical remission.\n                  <\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>The use of sitagliptin and vitamin D3 in patients with new-onset type 1 diabetes mellitus (T1DM) may help decrease the daily insulin requirement by delaying beta cell loss and improving endogenous insulin production.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The use of sitagliptin and vitamin D3 in new-onset T1DM could help regulate the imbalance between Th17 and Treg cells.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Age 14 years or above, absence of ketoacidosis and positive C-peptide levels in patients with T1DM are good criteria to predict prolonged T1DM remission.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>The determination of anti-GAD antibodies and C-peptide levels could be helpful in the follow-up of patients in use of sitagliptin and vitamin D3, which could be associated with prolonged T1DM clinical remission.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  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Afonso","family":"Torres","sequence":"additional","affiliation":[{"name":"3Laborat\u00f3rio Clinico do Hospital Israelita Albert Eistein, S\u00e3o Paulo, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"key20161221121515554_bib1","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1007\/s001250051197","article-title":"Immunological abnormalities in islets at diagnosis paralleled further deterioration of glycaemic control in patients with recent-onset Type I (insulin-dependent) diabetes mellitus","volume":"42","author":"Imagawa","year":"1999","journal-title":"Diabetologia"},{"key":"key20161221121515554_bib2","doi-asserted-by":"crossref","first-page":"92","DOI":"10.2337\/diabetes.54.1.92","article-title":"Defective suppressor function in CD4+ CD25+ T-cells from patients with type 1 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