Ivana Rabbone1, Fabrizio Barbetti2, Raffaella Gentilella3, Gilberto Mossetto3, Riccardo Bonfanti4, Claudio Maffeis5, Dario Iafusco6, Elvira Piccinno7. 1. Department of Paediatrics, University of Turin, 10126 Turin, Italy. Electronic address: ivana.rabbone@unito.it. 2. Department of Experimental Medicine and Surgery, University of Tor Vergata, 00133 Rome, Italy; Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy. 3. Eli Lilly Italia, 50019 Sesto Fiorentino, Florence, Italy. 4. Pediatric Department and Diabetes Research Institute (OSR-DRI), San Raffaele Scientific Hospital, 20132 Milan, Italy. 5. Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, 37126 Verona, Italy. 6. Regional Center of Pediatric Diabetology "G.Stoppoloni", Department of Women, Child and General Surgery, Second University of Naples, 80138 Naples, Italy. 7. Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, 70126 Bari, Italy.
Abstract
AIMS: Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS: A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS: Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates. No clinical trials of CSII in NDM have been reported. Case reports suggest that CSII is a safe and effective means of treating NDM. CSII was initiated to improve glycaemic control, for practicality and convenience, and to overcome difficulties associated with the maintenance of long-term intravenous catheters. CSII can provide better glycaemic control than multiple daily injections, with few hypoglycaemic events. Continuous glucose monitoring integrated with the pump helps provide more precise control of blood glucose levels. CSII generally uses short-acting insulin or rapid-acting insulin analogues, and those that are approved for use in neonates appear to be appropriate for the treatment of NDM using an insulin pump. CONCLUSIONS: Information from case reports indicates that CSII is safe and effective for the management of NDM.
AIMS: Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS: A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS: Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates. No clinical trials of CSII in NDM have been reported. Case reports suggest that CSII is a safe and effective means of treating NDM. CSII was initiated to improve glycaemic control, for practicality and convenience, and to overcome difficulties associated with the maintenance of long-term intravenous catheters. CSII can provide better glycaemic control than multiple daily injections, with few hypoglycaemic events. Continuous glucose monitoring integrated with the pump helps provide more precise control of blood glucose levels. CSII generally uses short-acting insulin or rapid-acting insulin analogues, and those that are approved for use in neonates appear to be appropriate for the treatment of NDM using an insulin pump. CONCLUSIONS: Information from case reports indicates that CSII is safe and effective for the management of NDM.