BACKGROUND: Recently, many patients with Kir6.2-related permanent neonatal diabetes mellitus (PNDM) have been successfully transferred from insulin therapy to sulfonylurea (SU) treatment. The long-term efficacy and safety of SU treatment in PNDM patients, however, have not yet been determined. METHODS: We monitored glycemic control and the occurrence of potential side effects in 14 Kir6.2-related PNDM patients from Poland (median age, 12.0 years; range, 5-50 years) who were transferred to SU therapy at least 2 years ago. Three of the 14 patients were lost to follow-up, whereas for the remaining 11 individuals the median follow-up was 34 months (range, 27-51 months). RESULTS: The initial reduction of glycated hemoglobin (HbA1c) after the switch to SU (approximately 3-6 months post-transfer) was 1.68% (range, 0.3-3.7%), and good metabolic control was maintained over the entire period of observation with an average HbA1c level of 6.0% (range, 5.3-6.7%) at the last visit. This was accompanied by a substantial drop in SU dose by 0.24 mg/kg, which constituted a 38.0% decrease. A rapid progression of retinal changes was observed in one patient, a 34-year-old woman at the beginning of the observation, with preexisting proliferative diabetic retinopathy. No causal relationship between these changes and SU treatment could be proven. Neither serious side effects nor progression of diabetes complications was observed in any other patients. No detrimental effect on growth in the observed minors was recorded. CONCLUSIONS: In summary, the switch from insulin therapy to SU treatment in PNDM related to KCNJ11 mutations was found to be an efficient and safe therapeutic method over a period of 34-month median follow-up. Although no serious side effects were associated with SU treatment, their use in Kir6.2 PNDM requires further attention, particularly in children, adolescents, and patients with advanced chronic diabetes complications.
BACKGROUND: Recently, many patients with Kir6.2-related permanent neonatal diabetes mellitus (PNDM) have been successfully transferred from insulin therapy to sulfonylurea (SU) treatment. The long-term efficacy and safety of SU treatment in PNDMpatients, however, have not yet been determined. METHODS: We monitored glycemic control and the occurrence of potential side effects in 14 Kir6.2-related PNDMpatients from Poland (median age, 12.0 years; range, 5-50 years) who were transferred to SU therapy at least 2 years ago. Three of the 14 patients were lost to follow-up, whereas for the remaining 11 individuals the median follow-up was 34 months (range, 27-51 months). RESULTS: The initial reduction of glycated hemoglobin (HbA1c) after the switch to SU (approximately 3-6 months post-transfer) was 1.68% (range, 0.3-3.7%), and good metabolic control was maintained over the entire period of observation with an average HbA1c level of 6.0% (range, 5.3-6.7%) at the last visit. This was accompanied by a substantial drop in SU dose by 0.24 mg/kg, which constituted a 38.0% decrease. A rapid progression of retinal changes was observed in one patient, a 34-year-old woman at the beginning of the observation, with preexisting proliferative diabetic retinopathy. No causal relationship between these changes and SU treatment could be proven. Neither serious side effects nor progression of diabetes complications was observed in any other patients. No detrimental effect on growth in the observed minors was recorded. CONCLUSIONS: In summary, the switch from insulin therapy to SU treatment in PNDM related to KCNJ11 mutations was found to be an efficient and safe therapeutic method over a period of 34-month median follow-up. Although no serious side effects were associated with SU treatment, their use in Kir6.2PNDM requires further attention, particularly in children, adolescents, and patients with advanced chronic diabetes complications.
Authors: Brian W Thurber; David Carmody; Elizabeth C Tadie; Ashley N Pastore; Jazzmyne T Dickens; Kristen E Wroblewski; Rochelle N Naylor; Louis H Philipson; Siri Atma W Greeley Journal: Diabetologia Date: 2015-04-17 Impact factor: 10.122
Authors: D Iafusco; C Bizzarri; F Cadario; R Pesavento; G Tonini; S Tumini; V Cauvin; C Colombo; R Bonfanti; F Barbetti Journal: Diabetologia Date: 2011-08-07 Impact factor: 10.122
Authors: Beate Karges; Thomas Meissner; Andrea Icks; Thomas Kapellen; Reinhard W Holl Journal: Nat Rev Endocrinol Date: 2011-11-29 Impact factor: 43.330
Authors: Evgenia Globa; Nataliya Zelinska; Deborah J G Mackay; Karen I Temple; Jayne A L Houghton; Andrew T Hattersley; Sarah E Flanagan; Sian Ellard Journal: J Pediatr Endocrinol Metab Date: 2015-11-01 Impact factor: 1.634
Authors: Melissa F Brereton; Michaela Iberl; Kenju Shimomura; Quan Zhang; Alice E Adriaenssens; Peter Proks; Ioannis I Spiliotis; William Dace; Katia K Mattis; Reshma Ramracheya; Fiona M Gribble; Frank Reimann; Anne Clark; Patrik Rorsman; Frances M Ashcroft Journal: Nat Commun Date: 2014-08-22 Impact factor: 14.919