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Differences between transient neonatal diabetes mellitus subtypes can guide diagnosis and therapy.

短暂性新生儿糖尿病亚型之间的差异可以指导诊断和治疗。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1030
  • 作者列表:"Bonfanti R","Iafusco D","Rabbone I","Diedenhofen G","Bizzarri C","Patera PI","Reinstadler P","Costantino F","Calcaterra V","Iughetti L","Savastio S","Favia A","Cardella F","Lo Presti D","Girtler Y","Rabbiosi S","D'Annunzio G","Zanfardino A","Piscopo A","Casaburo F","Pintomalli L","Russo L","Grasso V","Minuto N","Mucciolo M","Novelli A","Marucci A","Piccini B","Toni S","Silvestri F","Carrera P","Rigamonti A","Frontino G","Trada M","Tinti D","Delvecchio M","Rapini N","Schiaffini R","Mammì C","Barbetti F","Diabetes Study Group of ISPED.
  • 发表时间:2021-04-01
Abstract

Objective:Transient neonatal diabetes mellitus (TNDM) is caused by activating mutations in ABCC8 and KCNJ11 genes (KATP/TNDM) or by chromosome 6q24 abnormalities (6q24/TNDM). We wanted to assess whether these different genetic aetiologies result in distinct clinical features. Design:Retrospective analysis of the Italian data set of patients with TNDM. Methods:Clinical features and treatment of 22 KATP/TNDM patients and 12 6q24/TNDM patients were compared. Results:Fourteen KATP/TNDM probands had a carrier parent with abnormal glucose values, four patients with 6q24 showed macroglossia and/or umbilical hernia. Median age at diabetes onset and birth weight were lower in patients with 6q24 (1 week; -2.27 SD) than those with KATP mutations (4.0 weeks; -1.04 SD) (P = 0.009 and P = 0.007, respectively). Median time to remission was longer in KATP/TNDM than 6q24/TNDM (21.5 weeks vs 12 weeks) (P = 0.002). Two KATP/TNDM patients entered diabetes remission without pharmacological therapy. A proband with the ABCC8/L225P variant previously associated with permanent neonatal diabetes entered 7-year long remission after 1 year of sulfonylurea therapy. Seven diabetic individuals with KATP mutations were successfully treated with sulfonylurea monotherapy; four cases with relapsing 6q24/TNDM were treated with insulin, metformin or combination therapy. Conclusions:If TNDM is suspected, KATP genes should be analyzed first with the exception of patients with macroglossia and/or umbilical hernia. Remission of diabetes without pharmacological therapy should not preclude genetic analysis. Early treatment with sulfonylurea may induce long-lasting remission of diabetes in patients with KATP mutations associated with PNDM. Adult patients carrying KATP/TNDM mutations respond favourably to sulfonylurea monotherapy.

摘要

目的: 短暂性新生儿糖尿病 (TNDM) 是由ABCC8和KCNJ11基因激活突变 (KATP/TNDM) 或染色体6q24异常 (6q24/TNDM) 引起的。我们想评估这些不同的遗传病因是否导致不同的临床特征。 设计: 意大利TNDM患者数据集的回顾性分析。 方法: 对22例KATP/TNDM患者和12例6q24/TNDM患者的临床特点和治疗进行比较。 结果: 14例KATP/TNDM先证者父母中有1例血糖异常,4例6q24表现为巨舌症和/或脐疝。6q24 (1周; -2.27 SD) 患者的糖尿病发病的中位年龄和出生体重低于KATP突变患者 (4.0周; -1.04 SD) (分别为P = 0.009和P = 0.007)。KATP/TNDM的中位缓解时间长于6q24/TNDM (21.5周vs 12周) (P = 0.002)。两名KATP/TNDM患者在没有药物治疗的情况下进入糖尿病缓解。既往与永久性新生儿糖尿病相关的ABCC8/L225P变异的先证者在接受1年磺脲类治疗后进入7年长期缓解。7例具有KATP突变的糖尿病个体成功地用磺酰脲单药治疗; 4例复发6q24/TNDM患者用胰岛素、二甲双胍或联合治疗。 结论: 如果怀疑TNDM,应首先分析KATP基因,除了巨舌和/或脐疝患者。没有药物治疗的糖尿病缓解不应该排除遗传分析。早期使用磺酰脲类药物治疗可使与PNDM相关的KATP突变患者的糖尿病长期缓解。携带KATP/TNDM突变的成年患者对磺酰脲类单药治疗反应良好。

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影响因子:2.68
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DOI:10.1080/14656566.2020.1814255
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