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

Abstract

. Neonatal diabetes mellitus (NDM) is a rare metabolic disorder that is mainly present in the first 6 months of life and necessitates insulin treatment. Sensor-augmented pump (SAP) therapy has been widely used in children with type 1 diabetes mellitus, but its use in patients with NDM is limited. We report three patients with NDM who received SAP therapy using the MiniMed™ 640G system starting in the neonatal period. Two patients were treated for 3 months, and one patient continued treatment up to an age of 22 mo. The MiniMed 640G system can automatically suspend insulin delivery (SmartGuard™ Technology) to avoid hypoglycemia when the sensor glucose level is predicted to approach the predefined threshold. We suggest that SmartGuard Technology is particularly useful for infants in whom hypoglycemia cannot be identified. The MiniMed 640G system automatically records the trends of sensor glucose levels and the total daily dose of insulin, which can make the management more accurate and reduce the family’s effort. SAP therapy for patients with NDM automatically prevents severe hypoglycemia and is useful for long-term management; however, attention should be paid to its application.

Use of a long-term continuous glucose monitor for predicting sulfonylurea dose in patients with neonatal diabetes mellitus: a case series

“…SAP therapy is effective in patients with type 1 diabetes, regardless of age ( 34 ). Some studies have reported the benefits of CSII and CGM in patients with NDM ( 10 , 15 , 17 , 19 , 35 ). Three previous studies have shown that CGM is useful not only for insulin therapy, but also for switching to oral SU in patients with NDM with the KCNJ11 variant ( 19 , 35 , 36 ).…”

“…In contrast, patients with KCNJ11 and ABCC8 mutants are treated with oral sulfonylurea (SU) rather than insulin injection ( 3 ). Some studies have reported the effectiveness of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) in patients with NDM receiving insulin therapy ( 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ). However, few studies have reported the effectiveness of CGM in patients with NDM during and after switching to oral SU ( 18 , 19 ).…”

Successful Termination of Insulin Therapy in Transient Neonatal Diabetes Mellitus

“…We found SAP therapy to be effective for our patient with TNDM for the following reasons: First, a PLGM system predicted hypoglycemia from CGM data and automatically suspended insulin delivery by CSII [ 5 ]. Few prior reports have described the effectiveness of a PLGM system in patients with TNDM [ 6 ]. Here, we demonstrated how a PLGM system could function correctly in an infant patient without causing hypoglycemia.…”