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Nakagawa A, Hirano D, Inage Y, Yamada S, Kotake Y, Ikoma N, Kumazawa K, Hayashi S, Tanabe Y, Kobayashi M, Shimizu M. Experience with enteral sulfonylurea monotherapy for extremely low birth weight infants with hyperglycemia. Clin Pediatr Endocrinol 2022; 31:225-233. [PMID: 36405438 PMCID: PMC9637416 DOI: 10.1297/cpe.2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2022] Open
Abstract
Limited data are available on the effects of enteral sulfonylurea (SU) monotherapy in extremely low birth weight infants (ELBWIs) with hyperglycemia. Therefore, we report our experience
with enteral SU monotherapy for hyperglycemic ELBWIs. We retrospectively evaluated 11 hyperglycemic ELBWIs (seven male infants, median gestational age = 24.9 wk) who received SU between
January 2016 and December 2019. Blood glucose (BG) levels were monitored before and after SU initiation and evaluated for the occurrence of adverse effects. We administered SU at a median of
15 d (interquartile range [IQR]: 12–20 d) after birth, with the median maximum dose of 0.2 mg/kg/d (IQR: 0.125–0.3 mg/kg/d). Hyperglycemia improved in all patients, and the target BG levels
were achieved without severe side effects at a median of 6 d (IQR: 4–8.5 d) after initiation of treatment. The incidence of hypoglycemia during SU treatment was observed in 18 events per
1000 patient hours; however, the patients were asymptomatic. Based on these results, enteral SU monotherapy may be considered as an option for hyperglycemic ELBWIs.
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Affiliation(s)
- Ai Nakagawa
- Department of Pediatrics, Machida Municipal Hospital, Tokyo, Japan
| | - Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuka Inage
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Saya Yamada
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Kotake
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Naohiro Ikoma
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Kensuke Kumazawa
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Shion Hayashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yukitoshi Tanabe
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahisa Kobayashi
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masaki Shimizu
- Division of Neonatology, Saitama Children’s Medical Center, Saitama, Japan
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Garcin L, Mericq V, Fauret-Amsellem AL, Cave H, Polak M, Beltrand J. Neonatal diabetes due to potassium channel mutation: Response to sulfonylurea according to the genotype. Pediatr Diabetes 2020; 21:932-941. [PMID: 32418263 DOI: 10.1111/pedi.13041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE A precision medicine approach is used to improve treatment of patients with monogenic diabetes. Herein, we searched SU efficiency according to the genotype-phenotype correlation, dosage used, and side effects. RESEARCH DESIGN AND METHODS Systematic review conducted according the PRISMA control criteria identifying relevant studies evaluating the in vivo and in vitro sensitivity of ATP-dependent potassium channels according to the characteristics of genetic mutation. RESULTS Hundred and three selected articles with complete data in 502 cases in whom 413 (82.3%) had mutations in KCNJ11 (#64) and 89 in ABCC8 (# 56). Successful transfer from insulin to SU was achieved in 91% and 86.5% patients, respectively, at a mean age of 36.5 months (0-63 years). Among patients with KCNJ11 and ABCC8 mutations 64 and 46 were associated with constant success, 5 and 5 to constant failure, and 10 and 4 to variable degrees of reported success rate, respectively. The glibenclamide dosage required for each genotype ranged from 0.017 to 2.8 mg/kg/day. Comparing both the in vivo and in vitro susceptibility results, some mutations appear more sensitive than others to sulfonylurea treatment. Side effects were reported in 17/103 of the included articles: mild gastrointestinal symptoms and hypoglycaemia were the most common. One premature patient had an ulcerative necrotizing enterocolitis which association with SU is difficult to ascertain. CONCLUSIONS Sulfonylureas are an effective treatment for monogenic diabetes due to KCNJ11 and ABCC8 genes mutations. The success of the treatment is conditioned by differences in pharmacogenetics, younger age, pharmacokinetics, compliance, and maximal dose used.
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Affiliation(s)
- Laure Garcin
- Pediatric Gynecology Diabetes and Endocrinology, APHP Centre - Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Veronica Mericq
- Faculty of Medicine, Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Anne-Laure Fauret-Amsellem
- Département de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Paris, France.,Centre de référence national des maladies rares de la sécrétion d'insuline et de la sensibilité à l'insuline, PRISIS, Paris, France
| | - Helene Cave
- Département de Génétique, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Paris, France.,Centre de référence national des maladies rares de la sécrétion d'insuline et de la sensibilité à l'insuline, PRISIS, Paris, France.,Université de Paris, Paris, France
| | - Michel Polak
- Pediatric Gynecology Diabetes and Endocrinology, APHP Centre - Hôpital Universitaire Necker Enfants Malades, Paris, France.,Centre de référence national des maladies rares de la sécrétion d'insuline et de la sensibilité à l'insuline, PRISIS, Paris, France.,Université de Paris, Paris, France.,Institut IMAGINE, Paris, France.,Inserm U1016, Institut Cochin, Paris, France.,ENDO European Reference Network, Main Thematic Group 3, Genetic Disorders of Glucose and Insulin Homeostasis, European Reference Networks, Paris, France
| | - Jacques Beltrand
- Pediatric Gynecology Diabetes and Endocrinology, APHP Centre - Hôpital Universitaire Necker Enfants Malades, Paris, France.,Centre de référence national des maladies rares de la sécrétion d'insuline et de la sensibilité à l'insuline, PRISIS, Paris, France.,Université de Paris, Paris, France.,Institut IMAGINE, Paris, France.,Inserm U1016, Institut Cochin, Paris, France.,ENDO European Reference Network, Main Thematic Group 3, Genetic Disorders of Glucose and Insulin Homeostasis, European Reference Networks, Paris, France
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Beltrand J, Baptiste A, Busiah K, Bouazza N, Godot C, Boucheron A, Djerada Z, Gozalo C, Berdugo M, Tréluyer JM, Elie C, Polak M. Glibenclamide oral suspension: Suitable and effective in patients with neonatal diabetes. Pediatr Diabetes 2019; 20:246-254. [PMID: 30684309 DOI: 10.1111/pedi.12823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/25/2018] [Accepted: 12/17/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Results of genetic have led to off-label glibenclamide treatment in patients with neonatal diabetes (NDM) because of potassium channel mutations. No pediatric form of glibenclamide was available. Glibenclamide was designated an orphan drug designation for NDM and a suspension was developed. As a part of the pediatric plan investigation, we assessed its acceptability, efficiency, and safety. METHODS In this Phase II, prospective, non-randomized, single-center study, patient received glibenclamide tablets for 1 month then the suspension for 3 months. We assessed acceptability using hedonic scales and patient questionnaires, effectiveness using glycated hemoglobin (HbA1C) assays and safety based on hypo and hyperglycemia, and other adverse events. RESULTS We included 10 patients (0.1-16.2 years, 6 < 5 years) were included. Younger patients preferred the suspension and older the tablets. All parents were satisfied with the ease of suspension administration. The parents of 5 of 6 younger children preferred the suspension over the tablets and kept it. Switching from tablets to suspension did not affect the excellent metabolic control (median HbA1c change, -0.40%, [-1.3% to 0.5%] P = 0.08). Median frequencies of hypoglycemia and hyperglycemia were less than 5% of routine blood glucose assays and were similar with both dosage forms. Two patients each experienced one episode of hypoglycemia below 35 mg/dL highlighting the need for dosage titration when switching from tablets to suspension. Transient and non-severe abdominal pain or diarrhea occurred in three patients. None of the patients discontinued the treatment. CONCLUSION The glibenclamide oral suspension Amglidia, the first anti-diabetic drug specifically developed for pediatric patients, is acceptable, effective, and safe in patients with NDM (NCT02375828). CLINICAL TRIAL REGISTRATION Glibentek in Patients with Neonatal Diabetes Secondary to Mutations in K + -ATP Channels, clinicaltrials.gov, NCT02375828, https://clinicaltrials.gov/ct2/show/NCT02375828.
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Affiliation(s)
- Jacques Beltrand
- Pediatric diabetes and endocrinology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Medical School -Sorbonne Paris Cité university, Paris, France.,Inserm U1016, Cochin Institute, Paris, France.,Imagine Institute, Sorbonne Paris Cité university, Paris, France.,Centre deréférence national des maladies rares de la sécrétion d'insuline et de lasensibilité à l'insuline, PRISIS, Saint-Antoine hospital, Paris, France.,NeckerEnfants Malades Hospital, EnDOrare, MTG3, Genetic disordes of glucose andinsulin homeostasis, European Reference networks, Paris, France
| | - Amandine Baptiste
- Clinical research unit Paris Descartes Necker Cochin, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kanetee Busiah
- Pediatric diabetes and endocrinology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naim Bouazza
- Clinical research unit Paris Descartes Necker Cochin, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cecile Godot
- Pediatric diabetes and endocrinology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Adeline Boucheron
- Pediatric diabetes and endocrinology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Zoubir Djerada
- CHU Reims, Maison Blanche hospital, Laboratoire de Pharmacologie -Toxicologie, Reims, France
| | - Claire Gozalo
- CHU Reims, Maison Blanche hospital, Laboratoire de Pharmacologie -Toxicologie, Reims, France
| | - Marianne Berdugo
- Inserm U1138, Cordeliers research centre, Pierre et Marie Curie university, Paris, France
| | - Jean-Marc Tréluyer
- Paris Descartes Medical School -Sorbonne Paris Cité university, Paris, France.,Clinical research unit Paris Descartes Necker Cochin, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Clinical pharmacology unit, AP-HP, Cochin-Broca-Hôtel-Dieu hospital, Paris, France
| | - Caroline Elie
- Clinical research unit Paris Descartes Necker Cochin, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Polak
- Pediatric diabetes and endocrinology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Medical School -Sorbonne Paris Cité university, Paris, France.,Inserm U1016, Cochin Institute, Paris, France.,Imagine Institute, Sorbonne Paris Cité university, Paris, France.,Centre deréférence national des maladies rares de la sécrétion d'insuline et de lasensibilité à l'insuline, PRISIS, Saint-Antoine hospital, Paris, France.,NeckerEnfants Malades Hospital, EnDOrare, MTG3, Genetic disordes of glucose andinsulin homeostasis, European Reference networks, Paris, France
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