Successful treatment of young infants presenting neonatal diabetes mellitus with continuous subcutaneous insulin infusion before genetic diagnosis

Ivana Rabbone, Fabrizio Barbetti, Marco Marigliano, Riccardo Bonfanti, Elvira Piccinno, Federica Ortolani, Giovanna Ignaccolo, Claudio Maffeis, Santino Confetto, Franco Cerutti, Angela Zanfardino, Dario Iafusco

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Neonatal diabetes mellitus (NDM) is defined as hyperglycemia and impaired insulin secretion with onset within 6 months of birth. While rare, NDM presents complex challenges regarding the management of glycemic control. The availability of continuous subcutaneous insulin infusion pumps (CSII) in combination with continuous glucose monitoring systems (CGM) provides an opportunity to monitor glucose levels more closely and deliver insulin more safely. Methods: We report four cases of young infants with NDM successfully treated with CSII and CGM. Moreover, in two cases with Kir 6.2 mutation, we describe the use of CSII in switching therapy from insulin to sulfonylurea treatment. Results: Insulin pump requirement for the 4 neonatal diabetes cases was the same regardless of disease pathogenesis and c-peptide levels. No dilution of insulin was needed. The use of an integrated CGM system helped in a more precise control of BG levels with the possibility of several modifications of insulin basal rates. Moreover, as showed in the first two case-reports, when the treatment was switched from insulin to glibenclamide, according to identification of Kir 6.2 mutation and diagnosis of NPDM, the CSII therapy demonstrated to be helpful in allowing gradual insulin suspension and progressive introduction of sulfonylurea. Conclusions: During the neonatal period, the use of CSII therapy is safe, more physiological, accurate and easier for the insulin administration management. Furthermore, CSII therapy is safe during the switch of therapy from insulin to glibenclamide for infants with permanent neonatal diabetes mellitus.

Original languageEnglish
Pages (from-to)559-565
Number of pages7
JournalActa Diabetologica
Volume53
Issue number4
DOIs
Publication statusPublished - Aug 1 2016

Keywords

  • Continuous glucose monitoring systems (CGMS)
  • Continuous subcutaneous insulin infusion pumps (CSII)
  • Hyperglycemia
  • Neonatal diabetes mellitus

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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