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June 2018

SU treatment effective long-term in neonatal diabetes



A new study suggests that children with neonatal diabetes caused by a mutation in a specific gene can be successfully treated with sulfonylurea rather than insulin.

A decade-long analysis of 81 patients from 20 different countries shows that sulfonylurea (SU) can maintain ‘excellent’ blood sugar control in the long term.

Neonatal diabetes is diagnosed before the age of six months. Half of all cases are caused by a mutation in their KCNJ11 gene – which is involved in keeping insulin-producing beta cells in the pancreas working properly. This results in life threatening diabetes soon after birth.

The genetic diabetes research team at the University of Exeter Medical School discovered in 2006 that around half of people with neonatal diabetes could come off insulin injections and be treated more effectively with an SU.

Dr Pamela Bowman, University of Exeter Medical School, who led the study, said: ‘It was incredibly exciting to help people make the switch from insulin to simple tablets – but the question was, would the benefits last? Half of people with type 2 diabetes treated with sulfonylureas no longer have good blood sugar control after five years. Our study has found that in neonatal diabetes, the tablets are safe and they work long term – with 93% of people in the study remaining on sulfonylureas alone after 10 years, with excellent blood sugar control.’

Professor Andrew Hattersley, who heads the genetic diabetes research team at Exeter, said: ‘This is the first study to establish that this treatment works for at least 10 years and all indications are that it will continue to work for decades more. This is great news for the thousands of patients who have made the switch from insulin.’

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: ‘It’s so important that people living with rare forms of diabetes, like neonatal diabetes, receive the right diagnosis and treatment. That’s why we are delighted to have been able to help fund this vital work, demonstrating for the first time that sulphonylurea tablets are a safe and effective way for some people with neonatal diabetes to manage their condition for the long term. Moving forward, we hope research will uncover ways to prevent the developmental issues people with neonatal diabetes face.’

Bowman P, et al. The Lancet Diabetes & Endocrinology ePub 4 June 2018.

http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30106-2/fulltext

June 2018