Details

Autor(en) / Beteiligte

• Stanik, J.
• Dankovcikova, A.
• Barak, L.
• Skopkova, M.
• Palko, M.
• Divinec, J.
• Klimes, I.
• Gasperikova, D.

Titel

Sulfonylurea vs insulin therapy in individuals with sulfonylurea‐sensitive permanent neonatal diabetes mellitus, attributable to a KCNJ11 mutation, and poor glycaemic control

Ist Teil von

• Diabetic medicine, 2018-03, Vol.35 (3), p.386-391

Ort / Verlag

England: Wiley Subscription Services, Inc

Erscheinungsjahr

2018

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Therapy with sulfonylurea is preferable to insulin in the majority of individuals with KCNJ11 mutations, but not all of these people achieve target levels of HbA1c in long‐term follow‐up. We aimed to compare sulfonylurea therapy with insulin treatment in two sulfonylurea‐sensitive individuals with a KCNJ11 mutation who had poorly controlled permanent neonatal diabetes mellitus. Case report We report on two individuals with a KCNJ11 mutation (p.R201H) who are currently aged 35 (SVK1) and 21 years (SVK2). These individuals were switched from insulin to sulfonylurea in 2005. Data from the first 4 (SVK2) and 8 years (SVK1) of the follow‐up showed improved diabetes control and increased quality of life for both individuals. During the following years, however, both individuals failed to retain good diabetes control (HbA1c ≤ 53 mmol/mol; 7.0%). We therefore changed the therapy to a combination of insulin and sulfonylurea in both individuals, or to insulin monotherapy in SVK1, and compared the effects on HbA1c with those of sulfonylurea monotherapy. HbA1c levels in both individuals worsened after adding insulin to sulfonylurea [67 mmol/mol (8.3%) vs 77 mmol/mol (9.2%) in SVK1 and 106 mmol/mol (11.8%) vs 110±19 mmol/mol (12.2±1.7%) in SVK2], and after switching to only insulin therapy in SVK1 [57 mmol/mol (7.4%) vs 62 mmol/mol (7.8%)] when compared with sulfonylurea monotherapy. Discussion Our data show that sulfonylurea monotherapy might be preferable to insulin in people with permanent neonatal diabetes mellitus sensitive to sulfonylurea even when HbA1c is above target. What's new? Sulfonylurea therapy is preferable to insulin in the majority of individuals who have permanent neonatal diabetes mellitus (PNDM) with a KCNJ11 mutation; however, it is not known if sulfonylurea also improves insulin production in people with poor diabetes control. We report on two people with PNDM attributable to a KCNJ11 mutation (p.R201H). The individuals showed better diabetes control during the first years after switching to sulfonylurea, but failed to retain good diabetes control in the next period of the follow‐up. We showed that the switch to insulin monotherapy or a combination of sulfonylurea and insulin did not achieve better diabetes control.