Advertisement

Acta Diabetologica

, Volume 53, Issue 4, pp 559–565 | Cite as

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

  • Ivana RabboneEmail author
  • Fabrizio Barbetti
  • Marco Marigliano
  • Riccardo Bonfanti
  • Elvira Piccinno
  • Federica Ortolani
  • Giovanna Ignaccolo
  • Claudio Maffeis
  • Santino Confetto
  • Franco Cerutti
  • Angela Zanfardino
  • Dario Iafusco
Original Article

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.

Keywords

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

Notes

Acknowledgments

We would like to thank the Diabetes Study Group of Italian Society of Pediatric Endocrinology and Diabetology (ISPED) for the continuous collaboration and discussion on Neonatal Diabetes.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Polak M, Cavé H (2007) Neonatal diabetes mellitus: a disease linked to multiple mechanisms. Orphanet J Rare Dis 2(1):12–23CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Shield JPH, Gardner RJ, Wadsworth EJK et al (1997) Aetiopathology and genetic basis of neonatal diabetes. Arch Dis Child 76:F39–F42CrossRefGoogle Scholar
  3. 3.
    Polak M, Shield J (2004) Neonatal diabetes mellitus-genetic aspects. Pediatr Endocrinol Rev 2:193–198PubMedGoogle Scholar
  4. 4.
    Iafusco D, Stazi MA, Cotichini R, et al (2002) Prisco F Permanent diabetes mellitus in the first year of life. Diabetologia 45:798–804CrossRefPubMedGoogle Scholar
  5. 5.
    Jeha GS, Venkatesh MP, Edelen RC et al (2005) Neonatal diabetes mellitus: patient reports and review of current knowledge and clinical practice. J Pediatr Endocrinol Metab 18(11):1095–1102CrossRefPubMedGoogle Scholar
  6. 6.
    Ferguson SC, Blane A, Wardlaw J et al (2005) Influence of an early-onset age of type 1 diabetes on cerebral structure and cognitive function. Diabetes Care 28:1431–1437CrossRefPubMedGoogle Scholar
  7. 7.
    Hutchinson JH, Keay AJ, Kerr MM (1962) Congenital temporary diabetes mellitus. BMJ 2:436–440CrossRefGoogle Scholar
  8. 8.
    Marquis E, Robert JJ, Bouvattier C, et al (2002) Major difference in aetiology and phenotypic abnormalities between transient and permanent neonatal diabetes. J Med Genet 39(5):370–374CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Stoffers DA, Zinkin NT, Stanojevic V, et al (1997) Pancreatic agenesis attributable to a single nucleotide deletion in the human IPF1 gene coding sequence. Nat Genet 15:106–110CrossRefPubMedGoogle Scholar
  10. 10.
    Delepine M, Nicolino M, Barrett T (2000) EIF2AK3, encoding translation initiation factor-2-alpha kinase 3, is mutated in patients with Wolcott-Rallison syndrome. Nat Genet 25:406–409CrossRefPubMedGoogle Scholar
  11. 11.
    Njolstad PR, Sovik O, Cuesta-Munoz A et al (2001) Neonatal diabetes due to complete glucokinase deficiency. N Engl J Med 344:1588–1592CrossRefPubMedGoogle Scholar
  12. 12.
    Gloyn AL, Ewan DP, Pearson ER et al (2004) Activating mutations in the gene encoding the ATP-sensitive potassium channel subunit Kir6.2 and permanent neonatal diabetes. N Engl J Med 350:1838–1849CrossRefPubMedGoogle Scholar
  13. 13.
    Colombo C, Porzio O, Liu M et al (2008) Seven mutations in the human insulin gene linked to permanent neonatal/infancy-onset diabetes mellitus. J Clin Invest 118:2148–2156PubMedPubMedCentralGoogle Scholar
  14. 14.
    Shield JP (2007) Neonatal diabetes: how research unraveling the genetic puzzle has both widened our understanding of pancreatic development whilst improving children’s quality of life. Horm Res 67:77–83CrossRefPubMedGoogle Scholar
  15. 15.
    Northam EA, Anderson PJ, Jacobs R et al (2001) Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care 24:1541–1546CrossRefPubMedGoogle Scholar
  16. 16.
    Beardsall K, Ogilvy-Stuart AL, Ahluwalia J et al (2005) The continuous glucose monitoring sensor in neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 90:F307–F310CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Wintergerst KA, Hargadon S, Hsiang HY (2004) Continuous subcutaneous insulin infusion in neonatal diabetes mellitus. Pediatric Diabetes 5:202–206CrossRefPubMedGoogle Scholar
  18. 18.
    Bharucha T, Brown J, McDonnell C et al (2005) Neonatal diabetes mellitus: Insulin pump as an alternative management strategy. J Paediatr Child Health 41:522–526CrossRefPubMedGoogle Scholar
  19. 19.
    Olinder AL, Kernell A, Smide B (2006) Treatment with CSII in two infants with neonatal diabetes mellitus. Pediatr Diabetes 7(5):284–288CrossRefPubMedGoogle Scholar
  20. 20.
    Beardsall K, Pesterfield CL, Acerini CL (2011) Neonatal diabetes and insulin pump therapy. Arch Dis Child Fetal Neonatal Ed 96:F223–F224CrossRefPubMedGoogle Scholar
  21. 21.
    Passanisi S, Timpanaro T, Lo Presti D, et al (2014) Treatment of transient neonatal diabetes mellitus: insulin pump or insulin glargine? Our experience. Diabetes Technol Ther 16(12):880–884. doi: 10.1089/dia.2014.0055 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Ortolani F, Piccinno E, Grasso V et al (2015) Diabetes associated with dominant insulin gene mutations: outcome of 24-month, sensor-augmented insulin pump treatment. Acta Diabetol [Epub ahead of print]Google Scholar
  23. 23.
    Wolfsdorf JI, Allgrove J, Craig ME et al (2014) SPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 15(Suppl 20):154–179CrossRefPubMedGoogle Scholar
  24. 24.
    Pinelli L, Rabbone I, Salardi S et al (2008) Insulin pump therapy in child and adolescent with type 1 diabetes: the Italian viewpoint. Acta Biomed 79(1):57–64PubMedGoogle Scholar
  25. 25.
    Litton J, Rice A, Friedman N et al (2002) Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus. J Pediatr 141(4):490–495CrossRefPubMedGoogle Scholar
  26. 26.
    Maniatisa K, Klingensmith GJ, Sloverr H et al (1984) Continuous subcutaneous insulin infusion therapy for children and adolescents: an option for routine diabetes care. Pediatrics 107(2):351–356CrossRefGoogle Scholar
  27. 27.
    Fendler W, Fendler W, Baranowska AI, et al (2012) Three-year comparison of subcutaneous insulin pump treatment with multi-daily injections on HbA1c, its variability and hospital burden of children with type 1 diabetes. Acta Diabetol 49(5):363–370CrossRefPubMedGoogle Scholar
  28. 28.
    Ross PL, Milburn J, Reith DM, et al (2015) Clinical review: insulin-pump associated adverse events in adults and children. Acta Diabetol [Epub ahead of print]Google Scholar
  29. 29.
    Eli Lilly and Company Limited (2014) Humalog 100 U/ml, solution for injection in vial, Humalog 100 U/ml, solution for injection in Cartridge, Humalog KwikPen 100 U/ml, solution for injection: summary of product characteristics. Basingstoke, UKGoogle Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  • Ivana Rabbone
    • 1
    Email author
  • Fabrizio Barbetti
    • 2
    • 3
  • Marco Marigliano
    • 4
  • Riccardo Bonfanti
    • 5
  • Elvira Piccinno
    • 6
  • Federica Ortolani
    • 6
  • Giovanna Ignaccolo
    • 1
  • Claudio Maffeis
    • 4
  • Santino Confetto
    • 7
  • Franco Cerutti
    • 1
  • Angela Zanfardino
    • 7
  • Dario Iafusco
    • 7
  1. 1.Department of Pediatrics, Regina Margherita HospitalUniversity of TurinTurinItaly
  2. 2.Department of Experimental Medicine and SurgeryUniversity of Tor VergataRomeItaly
  3. 3.Bambino Gesù Children HospitalIRCCSRomeItaly
  4. 4.Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders UnitUniversity of VeronaVeronaItaly
  5. 5.Department of PediatricsOspedale San Raffaele Scientific InstituteMilanItaly
  6. 6.Department of Metabolic Diseases, Clinical Genetics and DiabetologyGiovanni XXIII Children’s HospitalBariItaly
  7. 7.Regional Center for Pediatric Diabetes “G.Stoppoloni”, Department of PediatricsSecond University of NaplesNaplesItaly

Personalised recommendations