Anybody who still shudders at the traumatizing memory of childhood booster shots will appreciate a recent UC Davis medical study that could mean the end of daily injections for infants afflicted with neonatal diabetes.
A trio of physicians led by Dr. Andrew Bremer, assistant professor of pediatric endocrinology at UC Davis Children’s Hospital, was able to rapidly transition a 20-week-old girl afflicted with neonatal diabetes, a rare condition requiring daily insulin shots, to an oral medication.
Bremer said the ability to treat diabetes orally instead of through the traditional insulin shots is a big step forward in terms of improving the quality of life for both children and their families.
“[Oral medication] relieves the family from having to administer subcutaneous insulin injections to their child with every meal,” Bremer said. “It allows children to have more freedom in their lives since they don’t have to worry about always having their insulin supplies.”
Permanent neonatal diabetes mellitus occurs in only one in 400,000 live births. It is usually diagnosed in infants shortly after birth and is caused by mutations in the insulin gene, which traditionally results in a lifelong dependence on insulin injections. It is different than the more common disorder, “childhood” type 1 diabetes, which results from autoimmune destruction of insulin-producing cells in the pancreas, according to an article published by the University of Chicago Medical Center.
The oral alternative used in the study is called Glyburide, a medicine commonly used to treat cases of type 2 diabetes, according to the U.S. National Library of Medicine.
In addition to transitioning the patient onto an oral medication, Bremer and his team were able to make the transition much more rapidly than in past cases.
“Using other outpatient protocols, the transition time could take up to six weeks,” Bremer said. “We made the transition with our patient in approximately two weeks.”
While oral medication is a safe alternative to insulin in many cases of neonatal diabetes, Bremer said it is not a universal solution for all patients.
“It all depends on what the underlying molecular defect is that is causing the neonatal diabetes,” Bremer said. “Unfortunately, not all children with permanent neonatal diabetes will be able to be treated with oral agents.”
Dr. Sayali Ranadive, Pediatric Endocrinology Fellow at UCSF and co-author of the report, said success with an oral medication is determined by the type of gene mutation causing the diabetes.
“Only neonatal diabetes, due to mutations in the specific gene, KCNJ11, which encodes a potassium channel in the insulin-secreting cells of the pancreas, has been successfully treated with oral medication,” Ranadive said. “With the KCNJ11 mutation, treatment with oral medications has a more stabilizing effect on overall blood sugar excursions than with treating with insulin.”
Bremer said he hopes the results of his study will lead to an increase in the use of oral alternatives to insulin where it is possible.
“[Our study] shows that transitioning a child with a form of neonatal diabetes that should be amenable to oral therapy can occur quickly and safely in the outpatient setting.”
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