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Tagawa K, Matsui K, Tsukamura A, Shibata M, Tsutsui H, Nagai S, Maruo Y. Use of a long-term continuous glucose monitor for predicting sulfonylurea dose in patients with neonatal diabetes mellitus: a case series. Clin Pediatr Endocrinol 2025; 33:131-138. [PMID: 38993723 PMCID: PMC11234181 DOI: 10.1297/cpe.2023-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 07/13/2024] Open
Abstract
Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes that presents with uncontrolled hyperglycemia during the first 6 months of life. NDM is a rare disease in which gene variants mainly cause β-cell loss or dysfunction (6q24 duplication, KCNJ11, and ABCC8). Although NDM is primarily treated through insulin therapy, it is highly challenging to manage blood glucose levels using insulin therapy during infancy. In contrast, KCNJ11 and ABCC8 mutant patients received oral sulfonylureas (SU) instead of insulin injections; however, the dose and frequency differ among individuals. Continuous glucose monitoring (CGM) is useful in patients with type 1 diabetes; but reports on patients with NDM are lacking. Herein, we report two cases of NDM with the KCNJ11 variant. We used CGM not only during insulin injection therapy but also after switching to oral SU therapy. The CGM data can also be used to determine the dose and frequency of SU. Furthermore, long-term CGM may be useful for adjusting SU dose and frequency, and maintaining good glycemic control not only during insulin injection but also during oral SU therapy.
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Affiliation(s)
- Koji Tagawa
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Sapporo Tokushukai Hospital, Hokkaido, Japan
| | - Katsuyuki Matsui
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Division of Endocrinology, Metabolism & Diabetes, Shiga Medical Center for Children, Shiga, Japan
| | - Atsushi Tsukamura
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masami Shibata
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Ogaki Municipal Hospital, Gifu, Japan
| | - Hidemi Tsutsui
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Shizuyo Nagai
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
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2
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Tarasiewicz M, Pietrzykowska A, Włodarczyk J, Seget S, Gadzalska K, Jakiel P, Skoczylas S, Jarosz-Chobot P, Borowiec M. Transient Neonatal Diabetes Mellitus with an Unknown Cause in a 1-Month-Old Infant: A Case Report. Healthcare (Basel) 2024; 12:1257. [PMID: 38998792 PMCID: PMC11241581 DOI: 10.3390/healthcare12131257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Transient neonatal diabetes mellitus (TNDM) is a genetically heterogeneous form of neonatal diabetes characterized by hyperglycemia that remits during infancy with a tendency to recur in later life. This case report presents the history of a male infant with transient neonatal diabetes mellitus. The patient was treated with a continuous subcutaneous insulin infusion (CSII) and a continuous glucose monitoring (CGM) system until the age of 2 months, when the normoglycemia connected with a withdrawal of treatment was noted. The genetic test results excluded the majority of known mutations related to TNDM. This case report focuses on various genetic mutations and the clinical features connected with them that cause TNDM and highlights the difficulties in the diagnostic and therapeutic processes of this disease. CSII and CGM systems seem to be a safe and effective treatment option in TNDM and may be used in the therapy.
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Affiliation(s)
- Mateusz Tarasiewicz
- Department of Children’s Diabetology and Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Anna Pietrzykowska
- Department of Children’s Diabetology and Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Julia Włodarczyk
- Department of Children’s Diabetology and Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Sebastian Seget
- Department of Children’s Diabetology and Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Karolina Gadzalska
- Department of Clinical Genetics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Paulina Jakiel
- Department of Clinical Genetics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Sebastian Skoczylas
- Department of Clinical Genetics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Przemysława Jarosz-Chobot
- Department of Children’s Diabetology and Pediatrics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Maciej Borowiec
- Department of Clinical Genetics, Medical University of Lodz, 90-419 Lodz, Poland
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3
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Torbjörnsdotter T, Marosvari‐Barna E, Henckel E, Corrias M, Norgren S, Janson A. Successful treatment of a cohort of infants with neonatal diabetes using insulin pumps including data on genetics and estimated incidence. Acta Paediatr 2020; 109:1131-1137. [PMID: 31746017 DOI: 10.1111/apa.15100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/11/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
AIM Neonatal diabetes is rare, and treatment is challenging. We present aspects on treatment, genetics and incidence. METHOD This was a prospective cohort study including all cases in our study area in Sweden. We compared with data from the National Diabetes Registry, the Neonatal Quality Register and the National Patient Register. RESULTS In the 19-year study period January 1, 1998 to December 31, 2016, we treated seven infants, five of them boys. Six patients used a subcutaneous insulin pump, and the smallest patient started at a weight of 938 g. Most important was for the pump to deliver minute doses of insulin and the design of cannulas and tubing. All patients could stop insulin treatment at 17-145 days of age. One patient relapsed at age 4.5 years. Four patients used the insulin pump after discharge. A mutation was identified in five patients, and this included all patients born after 30 weeks of gestation. The incidence of neonatal diabetes was 2/1 00 000, higher than previously estimated for Europe. Similar but lower incidences were reported in the registries. CONCLUSION Insulin pumps were safe in neonatal diabetes. All seven cases were transient. Neonatal diabetes was more common in our area than reported from Europe.
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Affiliation(s)
| | | | - Ewa Henckel
- Neonatal Intensive Care Unit Karolinska University Hospital Huddinge Sweden
- Division of Pediatrics Department of Clinical Science, Intervention and Technology Karolinska Institutet Huddinge Sweden
| | - Martino Corrias
- Neonatal Intensive Care Unit Karolinska University Hospital Huddinge Sweden
| | - Svante Norgren
- Pediatric Diabetes Unit Karolinska University Hospital Huddinge Sweden
- Division of Pediatric Endocrinology Department of Women´s and Children´s Health Karolinska Institutet Stockholm Sweden
| | - Annika Janson
- Pediatric Diabetes Unit Karolinska University Hospital Huddinge Sweden
- Division of Pediatric Endocrinology Department of Women´s and Children´s Health Karolinska Institutet Stockholm Sweden
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Iafusco D, Zanfardino A, Bonfanti R, Rabbone I, Tinto N, Iafusco F, Meola S, Gicchino MF, Ozen G, Casaburo F, Piscopo A, Miraglia Del Giudice E, Barbetti F. Congenital diabetes mellitus. Minerva Pediatr 2020; 72:240-249. [PMID: 32274916 DOI: 10.23736/s0026-4946.20.05838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital diabetes mellitus is a rare disorder characterized by hyperglycemia that occurs shortly after birth. We define "Diabetes of Infancy" if hyperglycemia onset before 6 months of life. From the clinical point of view, we distinguish two main types of diabetes of infancy: transient (TNDM), which remits spontaneously, and permanent (PNDM), which requires lifelong treatment. TNDM may relapse later in life. About 50% of cases are transient (TNDM) and 50% permanent. Clinical manifestations include severe intrauterine growth retardation, hyperglycemia and dehydration. A wide range of different associated clinical signs including facial dysmorphism, deafness and neurological, cardiac, kidney or urinary tract anomalies are reported. Developmental delay and learning difficulties may also be observed. In this paper we review all the causes of congenital diabetes and all genes and syndromes involved in this pathology. The discovery of the pathogenesis of most forms of congenital diabetes has made it possible to adapt the therapy to the diagnosis and in the forms of alteration of the potassium channels of the pancreatic Beta cells the switch from insulin to glibenclamide per os has greatly improved the quality of life. Congenital diabetes, although it is a very rare form, has been at the must of research in recent years especially for pathogenesis and pharmacogenetics. The most striking difference compared to the more frequent autoimmune diabetes in children (type 1 diabetes) is the possibility of treatment with hypoglycemic agents and the apparent lower frequency of chronic complications.
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Affiliation(s)
- Dario Iafusco
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy -
| | - Angela Zanfardino
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Riccardo Bonfanti
- Unit of Pediatric Diabetology, Department of Pediatrics, Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Ivana Rabbone
- Hub Regional Center of Pediatric Diabetology, Department of Science of Health, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Nadia Tinto
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Fernanda Iafusco
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Serena Meola
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Maria F Gicchino
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gulsum Ozen
- Department of Pediatrics, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Francesca Casaburo
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessia Piscopo
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Fabrizio Barbetti
- Department of Experimental Medicine, Tor Vergata University, Rome, Italy
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Rabbone I, Barbetti F, Gentilella R, Mossetto G, Bonfanti R, Maffeis C, Iafusco D, Piccinno E. Insulin therapy in neonatal diabetes mellitus: a review of the literature. Diabetes Res Clin Pract 2017; 129:126-135. [PMID: 28527303 DOI: 10.1016/j.diabres.2017.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
AIMS Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates. No clinical trials of CSII in NDM have been reported. Case reports suggest that CSII is a safe and effective means of treating NDM. CSII was initiated to improve glycaemic control, for practicality and convenience, and to overcome difficulties associated with the maintenance of long-term intravenous catheters. CSII can provide better glycaemic control than multiple daily injections, with few hypoglycaemic events. Continuous glucose monitoring integrated with the pump helps provide more precise control of blood glucose levels. CSII generally uses short-acting insulin or rapid-acting insulin analogues, and those that are approved for use in neonates appear to be appropriate for the treatment of NDM using an insulin pump. CONCLUSIONS Information from case reports indicates that CSII is safe and effective for the management of NDM.
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Affiliation(s)
- Ivana Rabbone
- Department of Paediatrics, University of Turin, 10126 Turin, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, 00133 Rome, Italy; Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | | | - Riccardo Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), San Raffaele Scientific Hospital, 20132 Milan, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, 37126 Verona, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G.Stoppoloni", Department of Women, Child and General Surgery, Second University of Naples, 80138 Naples, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, 70126 Bari, Italy
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Kaiserman K, Jung H, Benabbad I, Karges B, Polak M, Rosilio M. 20 Years of insulin lispro in pediatric type 1 diabetes: a review of available evidence. Pediatr Diabetes 2017; 18:81-94. [PMID: 27390032 DOI: 10.1111/pedi.12401] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/08/2016] [Accepted: 05/09/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Insulin lispro, the first rapid-acting insulin analog, was developed 20 years ago and has been studied in multiple situations and various populations. OBJECTIVE To review the literature on the use of insulin lispro in children, adolescents, and young adults. PATIENTS Children, adolescents, and young adults with type-1-diabetes. METHODS One hundred and twenty-two relevant publications, identified by a systematic (MEDLINE) and manual literature search, were reviewed. RESULTS Multiple daily injection (MDI) treatment with insulin lispro or other rapid-acting insulins, mainly using neutral protamine Hagedorn (NPH) insulin as the basal component, was associated with reduced postprandial glucose excursions, similar or improved HbA1c levels, and similar or reduced risks of severe hypoglycemia when compared with regular human insulin across all age-groups. Continuous subcutaneous insulin infusion (CSII)-treatment with insulin lispro also showed similar or improved glycemic control vs. MDI- or other CSII-regimens across all age-groups, without increasing the rate of severe hypoglycemia. The other two more recently developed rapid-acting insulins (aspart, glulisine) demonstrated non-inferiority to lispro on HbA1c. Long-term observational studies and real-life experience indicate that the increasing use of optimized MDI- and CSII-regimens with insulin lispro was associated with improvements in overall glycemic control. CONCLUSIONS For almost 20 years, rapid-acting insulins, in particular insulin lispro as the first-in-class, have contributed to broadening the treatment options for the unique needs of pediatric patients with type-1-diabetes across all age-groups, and have enabled more physiological insulin administration. Now widely used, they have allowed pediatric patients to safely reach better glycemic control, with more flexibility in their daily lives.
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Affiliation(s)
| | - Heike Jung
- Lilly Deutschland GmbH, Medical Department Diabetes, Bad Homburg, Germany
| | - Imane Benabbad
- Lilly France, Medical Department Diabetes, Neuilly-sur-Seine, France
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, German Center for Diabetes Research (DZD), RWTH Aachen University, Aachen, Germany
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades and Université Paris Descartes, Paris, France
| | - Myriam Rosilio
- Lilly France, Medical Department Diabetes, Neuilly-sur-Seine, France
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7
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Rabbone I, Barbetti F, Marigliano M, Bonfanti R, Piccinno E, Ortolani F, Ignaccolo G, Maffeis C, Confetto S, Cerutti F, Zanfardino A, Iafusco D. Successful treatment of young infants presenting neonatal diabetes mellitus with continuous subcutaneous insulin infusion before genetic diagnosis. Acta Diabetol 2016; 53:559-65. [PMID: 26831749 DOI: 10.1007/s00592-015-0828-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
Abstract
AIMS Neonatal diabetes mellitus (NDM) is defined as hyperglycemia and impaired insulin secretion with onset within 6 months of birth. While rare, NDM presents complex challenges regarding the management of glycemic control. The availability of continuous subcutaneous insulin infusion pumps (CSII) in combination with continuous glucose monitoring systems (CGM) provides an opportunity to monitor glucose levels more closely and deliver insulin more safely. METHODS We report four cases of young infants with NDM successfully treated with CSII and CGM. Moreover, in two cases with Kir 6.2 mutation, we describe the use of CSII in switching therapy from insulin to sulfonylurea treatment. RESULTS Insulin pump requirement for the 4 neonatal diabetes cases was the same regardless of disease pathogenesis and c-peptide levels. No dilution of insulin was needed. The use of an integrated CGM system helped in a more precise control of BG levels with the possibility of several modifications of insulin basal rates. Moreover, as showed in the first two case-reports, when the treatment was switched from insulin to glibenclamide, according to identification of Kir 6.2 mutation and diagnosis of NPDM, the CSII therapy demonstrated to be helpful in allowing gradual insulin suspension and progressive introduction of sulfonylurea. CONCLUSIONS During the neonatal period, the use of CSII therapy is safe, more physiological, accurate and easier for the insulin administration management. Furthermore, CSII therapy is safe during the switch of therapy from insulin to glibenclamide for infants with permanent neonatal diabetes mellitus.
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Affiliation(s)
- Ivana Rabbone
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
- Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Marco Marigliano
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Federica Ortolani
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Giovanna Ignaccolo
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Santino Confetto
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Franco Cerutti
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Angela Zanfardino
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Dario Iafusco
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
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8
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Kapellen TM, Heidtmann B, Lilienthal E, Rami-Merhar B, Engler-Schmidt C, Holl RW. Continuous Subcutaneous Insulin Infusion in Neonates and Infants Below 1 Year: Analysis of Initial Bolus and Basal Rate Based on the Experiences from the German Working Group for Pediatric Pump Treatment. Diabetes Technol Ther 2015; 17:872-9. [PMID: 26509360 DOI: 10.1089/dia.2015.0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diabetes mellitus is rare in young infants and neonates. Continuous subcutaneous insulin infusion (CSII) is used most frequently for insulin treatment in this age group. However, the individual doctor's experience is scarce because of the low prevalence of diabetes in this age. For this study patients treated with CSII with an age below 1 year were selected from the German/Austrian DPV (Diabetes-Patienten-Verlaufsdokumentation) database, and basal rate and bolus calculation were described. MATERIALS AND METHODS For all patients less than 1 year of age, basal rate and mealtime boluses were compared among infants with type 1 diabetes mellitus (T1DM), infants with neonatal diabetes mellitus (NDM), and infants with antibody status unknown diabetes mellitus (AUDM). RESULTS Fifty-eight patients with T1DM, 67 neonates with NDM, and 43 infants with early diabetes development after 6 months and negative β-cell antibodies (AUDM) could be analyzed. T1DM patients at onset required a median total insulin amount of 0.83 IU/kg of body weight, whereas NDM patients required 0.74 IU/kg of body weight (P = 0.63). Basal insulin requirement however, was different between the two groups (0.56 IU/kg of body weight in NDM vs. 0.43 IU/kg in T1DM) (P = 0.036). The percentage basal profile of NDM and T1DM patients was quite similar to children at the age of 1-5 years. The proportion of prandial insulin at onset was significantly different (32% in NDM vs. 53% in T1DM) (P < 0.00001). AUDM patients showed almost similar data to T1DM patients. The pattern of mealtime bolus insulin was not different among the groups. CONCLUSIONS The presented data can be used as an initial guide value to start CSII treatment in neonates and infants. To be on the safe side we recommend the lower quartile for the dosage as the starting value in nonketotic patients.
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Affiliation(s)
- Thomas M Kapellen
- 1 Hospital for Children and Adolescents, University of Leipzig , Leipzig, Germany
| | | | - Eggert Lilienthal
- 3 Hospital for Children and Adolescents, University of Bochum , Bochum, Germany
| | - Birgit Rami-Merhar
- 4 Department of Pediatrics, Medical University of Vienna , Vienna, Austria
| | | | - Reinhard W Holl
- 6 Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm , Ulm, Germany
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9
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Forsner M, Berggren J, Masaba J, Ekbladh A, Anna Lindholm AL. Parents’ experiences of caring for a child younger than two years of age treated with continuous subcutaneous insulin infusion. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Huang K, Liang L, Fu JF, Dong GP. Permanent neonatal diabetes mellitus in China. BMC Pediatr 2014; 14:188. [PMID: 25052923 PMCID: PMC4118223 DOI: 10.1186/1471-2431-14-188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background Permanent neonatal diabetes mellitus (PNDM) is a rare disease, which is defined as the onset of diabetes before the age of 6 months with persistence through life. Infants with KCNJ11 or ABCC8 genetic mutations may respond to oral sulfonylurea therapy. Currently, there are limited studies about the genetic analysis and long-term follow-up of PNDM. Case presentation We report four cases of PNDM. None of the infants or their parents had INS, KCNJ11, or ABCC8 genetic mutations. One infant underwent continuous subcutaneous insulin infusion (CSII) and the other infants underwent multiple injections of insulin (MII). In these infants, PNDM persisted from 35 months to 60 months of follow-up. Three infants maintained fairly stable blood sugar levels, and one infant had poor sugar control. Conclusions We suggest that all of the infants with PNDM should undergo genetic evaluation. For infants without KCNJ11 and ABCC8 genetic mutations, oral sulfonylurea should not be considered as treatment. CSII is a useful method for overcoming the difficulties of diabetes, and it may also improve the quality of life of both infants and their parents.
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Affiliation(s)
| | | | - Jun-Feng Fu
- Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine, 57 Zhugan Xiang, Hangzhou 310003, China.
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11
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Mianowska B, Szadkowska A, Fendler W, Mlynarski W. Use of lispro insulin diluted with normal saline to 10 U/ml in an insulin pump: case report. J Diabetes Sci Technol 2012; 6:1238-9. [PMID: 23063053 PMCID: PMC3570861 DOI: 10.1177/193229681200600531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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12
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Beardsall K, Acerini C, Dunger DB. Physiological and clinical role of insulin in the neonate. Expert Rev Endocrinol Metab 2010; 5:197-207. [PMID: 30764046 DOI: 10.1586/eem.09.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the newborn infant, insulin secretion has to adjust in response to the switch from a regulated and continuous placental supply of glucose in utero to the delivery of intermittent oral feeds postnatally. Changes in insulin secretion must reflect its primary role for maintaining glucose homeostasis, but also its roles in promoting growth and anabolism and in the newborn disorders of insulin secretion or sensitivity, which present with hyperglycemia and impaired growth. Recent elucidation of the genetic basis of neonatal diabetes has helped to provide valuable insights into the molecular mechanisms of β-cell function and the potential for treatment of some patients with oral hypoglycemic agents, although the majority require prolonged subcutaneous insulin treatment, which may prove challenging. The recent development of insulin pump therapy has significantly improved the clinical management of these infants. Although they do not have neonatal diabetes, the preterm or very-low-birthweight infant, subjected to the combined effects of insulin resistance owing to the impact of intensive care, and relative insulin deficiency related to prematurity, may have long periods of hyperglycemia and impaired growth, which have been associated with adverse clinical outcomes. Although these infants often require insulin treatment, the optimal management of glucose control and use of insulin has not been determined and remains controversial.
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Affiliation(s)
- Kathryn Beardsall
- a Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's University Hospital NHS Trust, Hills Road, Cambridge CB2 0QQ, UK.
| | - Carlo Acerini
- b Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's University Hospital NHS Trust, Hills Road, Cambridge CB2 0QQ, UK.
| | - David B Dunger
- c Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's Hospital University Trust, Hills Road, Cambridge CB2 0QQ, UK.
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