Treatment of Transient Neonatal Diabetes Mellitus: Insulin Pump or Insulin Glargine? Our Experience

Abstract

Neonatal diabetes mellitus (NDM) results from impaired insulin secretion, occurring within the first 6 months of life. NDM is classified as transient NDM (TNDM) or permanent NDM. To date there are no universal guidelines regarding its management. Intravenous insulin infusion represents the first and most adequate therapeutic approach for sustained hyperglycemia, but this can provide only a short-term solution. Several factors should be taken into account in the choice of the long-term treatment. We describe our experience with two infants affected by TNDM. The first child was treated with continuous subcutaneous insulin infusion, whereas the second infant was treated with subcutaneous insulin glargine injections. Our experience shows that the two different therapeutic approaches, if properly managed, are equally effective.

Conventional insulin pump therapy in two neonatal diabetes patients harboring the homozygous PTF1A enhancer mutation: Need for a novel approach for the management of neonatal diabetes

“…Large numbers of clinical studies have established that CSII in pediatrics is safe and effective. 10,11 This experience appears to be similar to others who have also managed infants with neonatal diabetes. [6][7][8][9] It has been difficult to manage these infants with CSII because of inconsistency of appetite and feeding schedule, malabsorption, subcutaneous infections at the pump site insertion, and frequent illnesses.…”

“…Good glycemic control is important, since hypoglycemia, as well as hyperglycemia, have been linked to adverse neurological outcomes. [7][8][9][10][11][12][13] The combination of CSII and CBGM has allowed detailed data to be obtained on glucose control in patients with diabetes, and especially in very young children and adolescents its use has increased remarkably over the last years in many countries. Large numbers of clinical studies have established that CSII in pediatrics is safe and effective.…”

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

“…Стандартное управление гипергликемией у новорожденных, целью которого является достиже-ние эугликемии, включает в себя ограничение по-ступления глюкозы в организм ребенка и терапию препаратами экзогенного инсулина [16].…”

“…При помощи ин-сулиновой помпы можно осуществлять введение небольших доз инсулина (около 0,05 единицы), в то время как наименьшая доза инсулина, которая может быть точно и без разведения введена при по-мощи шприца, составляет 0,5 единицы. Однако до настоящего времени не существует консенсуса по использованию инсулиновой помпы у новорож-денных с TNDM [27,28,16].…”

<p>Recent Advances in Neonatal Diabetes</p>

“…Infants can also receive long-acting insulin such as glargine at a dose of 0.2-0.4 unit/kg/day in 1 or 2 injections per day. 38,39 Infants with neonatal diabetes are susceptible to hypoglycemia because of the relatively low insulin requirements. Total daily insulin requirements can vary from 0.29 U/kg to 1.4 U/kg/day.…”