Successful treatment of a cohort of infants with neonatal diabetes using insulin pumps including data on genetics and estimated incidence

Abstract

Neonatal diabetes mellitus (NDM) is defined as diabetes with an onset before six months of age. NDM can either be transient (TNDM) or remain as permanent neonatal diabetes mellitus (PNDM). The prevalence of PNDM has been reported as one in 215 000 children in Slovakia 1 and one in 260 000 children in three other European countries: the UK, the Netherlands and Poland. 2 Other authors have proposed that NDM is less rare, with the minimal incidence of NDM (PNDM and TNDM) in Italy estimated to one in 90 000. 3 Also, a higher incidence of PNDM of one in 40 000 has been reported from Oman where consanguineous marriages are more common. 4,5 Among patients undergoing genetic testing, PNDM constitutes 40%-50% of cases of NDM. 6 More than 30 different genetic causes have been described in any of the biological pathways that regulate glucose homeostasis by affecting mechanisms of insulin release or pancreatic development and sustainability. Some of the more

Long-term sensor-augmented pump therapy for neonatal diabetes mellitus: a case series

“…Although the published experience of SAP therapy for patients with NDM is limited, SAP therapy has been demonstrated to be safe and more effective in obtaining adequate metabolic control in patients with NDM ( 16 , 18 , 19 ). For the long-term management of patients with NDM, it is extremely important to confirm their daily blood glucose levels and insulin doses.…”

Highlights in this issue

“…Neonatal diabetes is rare, and treatment is challenging. From 1998 to 2016, seven infants were treated at the Karolinska University Hospital in Sweden, and a subcutaneous insulin pump was used in six cases 4 . The smallest patient started treatment at a weight of 938 g. Parents were able to treat their child at home with the pump, which had well‐designed cannulas and tubing for this age group and delivered tiny doses of insulin.…”

Genetic spectrum of neonatal diabetes

“…In the patients who did not react favorably to sulfonylurea, therapy with insulin was necessary [24]. Therefore, genetic testing is mandatory for individualized treatment, improved outcome, and a better quality of life (QoL) [58,[79][80][81].…”

“…Molecular diagnosis of NDM is of the utmost importance as it provides the appropriate selection of therapy [77][78][79], which is in concordance with precision medicine [101]. It is also economically valuable as it provides the opportunity for transfer to oral therapy in certain patients [102,103], improving the QoL, and decreasing the cost of treatment [104].…”