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Switch from insulin to sulfonylureas improves HbA1c in neonatal diabetes
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Children with neonatal diabetes caused by a potassium channel mutation who were transferred from insulin to sulfonylurea therapy for more than 5 years saw a sustained improvement in HbA1c from baseline, according to study findings presented at the annual meeting of the European Society for Paediatric Endocrinology in Paris.
“Sulfonylureas have proven to be effective in patients with monogenic diabetes owing to potassium channel mutations,” Jacques Beltrand, MD, PhD, of Necker-Enfants Malades Hospital in Paris, and colleagues wrote. “They allow the discontinuation of insulin and a good metabolic control. Long-term data arguing for a persistent beneficial effect of [sulfonylurea therapy] are missing.”
In a retrospective study, Beltrand and colleagues analyzed data from 28 children participating in a French neonatal glibenclamide study group who were successfully transferred to sulfonylurea therapy (no insulin therapy during the 12 months after the switch) for more than 5 years (18 boys; mean baseline HbA1c, 7.4%; median time until start of sulfonylurea therapy, 9.32 years; median follow-up time, 6.6 years). Within the cohort, 24 children had KCNJ11 mutations; four had ABCC8 mutations; median age at transfer from insulin to sulfonylurea therapy was 4.9 years. Researchers assessed HbA1c at baseline and last follow-up visit, as well as adverse events, diabetes-related complications and sulfonylurea dosage.
At last follow-up visit, mean HbA1c was 6.1%, a median change of –1.4% (P < .001). Median glibenclamide dosage was 0.16 mg/kg per day at last visit. Researchers did not observe any episodes of renal or hepatic failure; there were no reports of the development of retinopathy or nephropathy. Insulin was reintroduced permanently in one patient (3 years after sulfonylurea transfer) and transiently in another (1 year after transfer and during 4 years).
“While prescribed off-label, [sulfonylureas] display a beneficial metabolic effect maintained over time with an extremely good safety profile in patients with neonatal diabetes owing to [a] potassium channel mutation,” the researchers wrote. – by Regina Schaffer
Reference: Hoarau M, et al. Abstract #FC5.4. Presented at: 55th Annual Meeting of the European Society for Paediatric Endocrinology; Sept. 10-12, 2016; Paris.
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