Management of diabetes mellitus in infants

Abstract

Diabetes mellitus diagnosed during the first 2 years of life differs from the disease in older children regarding its causes, clinical characteristics, treatment options and needs in terms of education and psychosocial support. Over the past decade, new genetic causes of neonatal diabetes mellitus have been elucidated, including monogenic β-cell defects and chromosome 6q24 abnormalities. In patients with KCNJ11 or ABCC8 mutations and diabetes mellitus, oral sulfonylurea offers an easy and effective treatment option. Type 1 diabetes mellitus in infants is characterized by a more rapid disease onset, poorer residual β-cell function and lower rate of partial remission than in older children. Insulin therapy in infants with type 1 diabetes mellitus or other monogenic causes of diabetes mellitus is a challenge, and novel data highlight the value of continuous subcutaneous insulin infusion in this very young patient population. Infants are entirely dependent on caregivers for insulin therapy, nutrition and glucose monitoring, which emphasizes the need for appropriate education and psychosocial support of parents. To achieve optimal long-term metabolic control with low rates of acute and chronic complications, continuous and structured diabetes care should be provided by a multidisciplinary health-care team.

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

“…Glibenclamide inhibits the K ATP channel, thereby stimulating insulin production. In patients with a proven K ATP channel defect, insulin treatment can be switched to oral glibenclamide therapy, even many years after diagnosis 3 4. This case report shows that a therapy switch results in a better glucose management.…”

Транзиторный неонатальный сахарный диабет, ассоциированный с нарушением импринтинга хромосомы 6q24 Часть 4. Дифференциальная диагностика и лечение

“…Расчет коли-чества углеводов необходим для определения дозы инсулина. Режим дробного питания является более благоприятным для достижения гликемического контроля [19]. Пациентам с низкой и очень низкой массой тела необходимо парентеральное питание.…”

“…У новорожденных с полным парентеральным питанием или непрерывным энте-ральным питанием при непрерывном инфузионном подкожном введении препарата достаточно толь-ко базального инсулина. При переходе на грудное вскармливание доля базального инсулина обычно составляет 30 % [19]. …”

“…В случаях очень низкой потребности в инсулине ( 0,02 Ед/ч) возможно применение разведенного инсулина [19].…”

Permanent neonatal diabetes mellitus in China

“…Permanent neonatal diabetes mellitus (PNDM), which refers to the onset of diabetes before the age of 6 months with persistence through life, is a rare disorder with an incidence ranging from 1:210,000 to 1:260,000 [1,2]. Together, activating mutations in KCNJ11 and ABCC8 genes, that encode the Kir6.2 andsulfonylurea receptor 1 (SUR1) subunits, respectively, account for more than 40% of PNDM cases [3].…”