A ‘picturesque’ case of transition from subcutaneous to oral treatment in neonatal diabetes

Verstappen, Stephanie; Mul, Dick

doi:10.1136/bcr-2013-202912

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Sulfonylurea therapy has considerable therapeutic benefits. First, the marked fluctations in blood glucose characteristic of insulin therapy are absent 31 , 32 . Second, control of glucose homeostasis dramatically improves, as indicated by a lower HbA1c level [7] .…”

Section: Sulfonylurea Therapy In Ndmentioning

confidence: 99%

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Neonatal Diabetes and the K ATP Channel: From Mutation to Therapy

Ashcroft

Puljung

Vedovato

2017

Trends in Endocrinology & Metabolism

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Activating mutations in one of the two subunits of the ATP-sensitive potassium (KATP) channel cause neonatal diabetes (ND). This may be either transient or permanent and, in approximately 20% of patients, is associated with neurodevelopmental delay. In most patients, switching from insulin to oral sulfonylurea therapy improves glycemic control and ameliorates some of the neurological disabilities. Here, we review how KATP channel mutations lead to the varied clinical phenotype, how sulfonylureas exert their therapeutic effects, and why their efficacy varies with individual mutations.

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Section: Sulfonylurea Therapy In Ndmentioning

confidence: 99%

“…Transfer to sulfonylurea therapy restores meal-stimulated insulin release [7] and decreases fluctuations in blood glucose 31 , 32 . Restoration of the beta cell incretin response and the amplifying effects of glucose likely contribute to these important effects.…”

Section: Why Is Glucose Homeostasis Better On Sulfonylurea Therapy?mentioning

confidence: 99%

Neonatal Diabetes and the K ATP Channel: From Mutation to Therapy

Ashcroft

Puljung

Vedovato

2017

Trends in Endocrinology & Metabolism

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“…Sulphonylurea drugs are used to treat patients with neonatal diabetes as they selectively block the open K ATP channels9. This results in far better glycaemic control, with fewer fluctuations in plasma glucose concentration, a lower HbA1C, a reduced incidence of hypoglycaemia and a simpler medication regime101112131415.…”

mentioning

confidence: 99%

Hyperglycaemia induces metabolic dysfunction and glycogen accumulation in pancreatic β-cells

et al. 2016

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Insulin secretion from pancreatic β-cells is impaired in all forms of diabetes. The resultant hyperglycaemia has deleterious effects on many tissues, including β-cells. Here we show that chronic hyperglycaemia impairs glucose metabolism and alters expression of metabolic genes in pancreatic islets. In a mouse model of human neonatal diabetes, hyperglycaemia results in marked glycogen accumulation, and increased apoptosis in β-cells. Sulphonylurea therapy rapidly normalizes blood glucose levels, dissipates glycogen stores, increases autophagy and restores β-cell metabolism. Insulin therapy has the same effect but with slower kinetics. Similar changes are observed in mice expressing an activating glucokinase mutation, in in vitro models of hyperglycaemia, and in islets from type-2 diabetic patients. Altered β-cell metabolism may underlie both the progressive impairment of insulin secretion and reduced β-cell mass in diabetes.

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“…In addition, multistep dilution is required because of the low body weight of these infants which makes titration of insulin dose difficult, thus making BG levels prone to wide fluctuations (30). Conversely, the BG levels in patients who received oral SU were within the physiological range in comparison to insulin treatment (31,32). In our patients, the BG levels did not show wide fluctuations and after starting SU treatment, the dose could be easily titrated.…”

mentioning

confidence: 75%

Experience with enteral sulfonylurea monotherapy for extremely low birth weight infants with hyperglycemia

Nakagawa

Hirano

Inage

et al. 2022

Clin Pediatr Endocrinol

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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. Highlights• This is the first case series of SU treatment in hyperglycemic ELBWIs• SU can be helpful in decreasing blood glucose levels in hyperglycemic ELBWIs• Further studies are required to evaluate efficacy and safety of SU in ELBWIs

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A ‘picturesque’ case of transition from subcutaneous to oral treatment in neonatal diabetes

Cited by 4 publications

References 5 publications

Neonatal Diabetes and the K ATP Channel: From Mutation to Therapy

Neonatal Diabetes and the K ATP Channel: From Mutation to Therapy

Hyperglycaemia induces metabolic dysfunction and glycogen accumulation in pancreatic β-cells

Experience with enteral sulfonylurea monotherapy for extremely low birth weight infants with hyperglycemia

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