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Tagawa K, Matsui K, Tsukamura A, Shibata M, Tsutsui H, Nagai S, Maruo Y. Use of a long-term continuous glucose monitor for predicting sulfonylurea dose in patients with neonatal diabetes mellitus: a case series. Clin Pediatr Endocrinol 2025; 33:131-138. [PMID: 38993723 PMCID: PMC11234181 DOI: 10.1297/cpe.2023-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/17/2024] [Indexed: 07/13/2024] Open
Abstract
Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes that presents with uncontrolled hyperglycemia during the first 6 months of life. NDM is a rare disease in which gene variants mainly cause β-cell loss or dysfunction (6q24 duplication, KCNJ11, and ABCC8). Although NDM is primarily treated through insulin therapy, it is highly challenging to manage blood glucose levels using insulin therapy during infancy. In contrast, KCNJ11 and ABCC8 mutant patients received oral sulfonylureas (SU) instead of insulin injections; however, the dose and frequency differ among individuals. Continuous glucose monitoring (CGM) is useful in patients with type 1 diabetes; but reports on patients with NDM are lacking. Herein, we report two cases of NDM with the KCNJ11 variant. We used CGM not only during insulin injection therapy but also after switching to oral SU therapy. The CGM data can also be used to determine the dose and frequency of SU. Furthermore, long-term CGM may be useful for adjusting SU dose and frequency, and maintaining good glycemic control not only during insulin injection but also during oral SU therapy.
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Affiliation(s)
- Koji Tagawa
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Sapporo Tokushukai Hospital, Hokkaido, Japan
| | - Katsuyuki Matsui
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Division of Endocrinology, Metabolism & Diabetes, Shiga Medical Center for Children, Shiga, Japan
| | - Atsushi Tsukamura
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Masami Shibata
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Ogaki Municipal Hospital, Gifu, Japan
| | - Hidemi Tsutsui
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Shizuyo Nagai
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
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Panza R, Cattivera V, Colella J, Baldassarre ME, Capozza M, Zagaroli L, Iezzi ML, Laforgia N, Delvecchio M. Insulin Delivery Technology for Treatment of Infants with Neonatal Diabetes Mellitus: A Systematic Review. Diabetes Ther 2024:10.1007/s13300-024-01653-z. [PMID: 39292435 DOI: 10.1007/s13300-024-01653-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] Open
Abstract
Neonatal diabetes mellitus is a rare disorder of glucose metabolism with onset within the first 6 months of life. The initial treatment is based on insulin infusion. The technologies for diabetes treatment can be very helpful, even if guidelines are still lacking. The current study aimed to provide a comprehensive review of the literature about the safety and efficacy of insulin treatment with technology for diabetes to support clinicians in the management of infants with neonatal diabetes mellitus. A total of 22 papers were included, most of them case reports or case series. The first infants with neonatal diabetes mellitus treated with insulin pumps were described nearly two decades ago. Over the years, continuous glucose monitoring systems were added to treat these individuals, allowing for a better customization of insulin administration. Insulin was diluted in some cases to further minimize the doses. Improvement in technology for diabetes prompted clinicians to use new devices and algorithms for insulin delivery in infants with neonatal diabetes as well. These systems are safe and effective, may shorten hospital stay, and help clinicians weaning insulin during the remission phase in the transient forms or switching from insulin to sulfonylurea when suggested by the molecular diagnosis. New technologies for insulin delivery in infants with neonatal diabetes can be used safely and closed-loop algorithms can work properly in these situations, optimizing blood glucose control.
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Affiliation(s)
- Raffaella Panza
- Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Valentina Cattivera
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Jacopo Colella
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Maria Elisabetta Baldassarre
- Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Manuela Capozza
- Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Luca Zagaroli
- Unit of Pediatrics, San Salvatore Hospital, ASL 1 Abruzzo, 67100, L'Aquila, Italy
| | - Maria Laura Iezzi
- Unit of Pediatrics, San Salvatore Hospital, ASL 1 Abruzzo, 67100, L'Aquila, Italy
| | - Nicola Laforgia
- Section of Neonatology and NICU, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124, Bari, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
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Abstract
Neonatal diabetes mellitus (DM) is defined by the onset of persistent hyperglycemia within the first six months of life but may present up to 12 months of life. A gene mutation affecting pancreatic beta cells or synthesis/secretion of insulin is present in more than 80% of the children with neonatal diabetes. Neonatal DM can be transient, permanent, or be a component of a syndrome. Genetic testing is important as a specific genetic mutation can significantly alter the treatment and outcome. Patients with mutations of either KCNJ11 or ABCC8 that encode subunits of the KATP channel gene mutation can be managed with sulfonylurea oral therapy while patients with other genetic mutations require insulin treatment.
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Affiliation(s)
- Amanda Dahl
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Correspondence: Seema Kumar Division of Pediatric Endocrinology and Metabolism, Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN55590, USATel +1 507-284-3300Fax +1 507-284-0727 Email
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Barbetti F, D'Annunzio G. Genetic causes and treatment of neonatal diabetes and early childhood diabetes. Best Pract Res Clin Endocrinol Metab 2018; 32:575-591. [PMID: 30086875 DOI: 10.1016/j.beem.2018.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Diabetes mellitus and impaired fasting glucose associated with single gene mutations are less rare than previously thought and may account for more than 6% of patients attending a pediatric diabetes clinic. The number of loci involved in monogenic diabetes exceed 25, and appropriate genetic diagnosis is crucial to direct therapy, for genetic counseling and for prognosis of short- and long-term complications. Among patients with neonatal diabetes (i.e. with onset within first 6 months of life) and patients with Maturity Onset Diabetes of the Young (MODY; an autosomal dominant form of diabetes), those carrying mutations in KCNJ11, ABCC8, HNF1A and HNF4A genes usually respond to oral therapy with sulphonylurea, while those bearing GCK mutations do not necessitate any treatment. Sensor-augmented continuous subcutaneous insulin infusion has been successfully employed in neonatal diabetes, and long-lasting effectiveness of sulfonylurea in KCNJ11 mutation carriers with neonatal diabetes well documented.
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Affiliation(s)
- Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier, 100133 Rome, Italy; S. Pietro Fatebenefratelli Hospital, 00189 Rome, Italy.
| | - Giuseppe D'Annunzio
- Pediatric Clinic, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.
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Gole E, Oikonomou S, Ellard S, De Franco E, Karavanaki K. A Novel KCNJ11 Mutation Associated with Transient Neonatal Diabetes. J Clin Res Pediatr Endocrinol 2018; 10:175-178. [PMID: 28943514 PMCID: PMC5985388 DOI: 10.4274/jcrpe.5166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Neonatal diabetes mellitus (NDM) is a rare type of monogenic diabetes that presents in the first 6 months of life. Activating mutations in the KCNJ11 gene encoding for the Kir6.2 subunit of the ATP-sensitive potassium (KATP ) channel can lead to transient NDM (TNDM) or to permanent NDM (PNDM). A female infant presented on the 22nd day of life with severe hyperglycemia and ketoacidosis (glucose: 907mg/dL, blood gas pH: 6.84, HCO3: 6 mmol/L). She was initially managed with intravenous (IV) fluids and IV insulin. Ketoacidosis resolved within 48 hours and she was started on subcutaneous insulin injections with intermediate acting insulin NPH twice daily requiring initially 0.75-1.35 IU/kg/d. Pre-prandial C-peptide levels were 0.51 ng/mL (normal: 1.77-4.68). Insulin requirements were gradually reduced and insulin administration was discontinued at the age of 10 months with subsequent normal glucose and HbA1c levels. C-peptide levels normalized (pre-prandial: 1.6 ng/mL, postprandial: 2 ng/mL). Genetic analysis identified a novel missense mutation (p.Pro254Gln) in the KCNJ11 gene. We report a novel KCNJ11 mutation in a patient who presented in the first month of life with a phenotype of NDM that subsided at the age of 10 months. It is likely that the novel p.P254Q mutation results in mild impairment of the KATP channel function leading to TNDM.
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Affiliation(s)
- Evangelia Gole
- University of Athens, 2nd Department of Pediatrics, “P&A Kyriakou” Children’s Hospital, Diabetes and Metabolism Unit, Athens, Greece
| | - Stavroula Oikonomou
- University of Athens, 2nd Department of Pediatrics, “P&A Kyriakou” Children’s Hospital, Diabetes and Metabolism Unit, Athens, Greece
| | - Sian Ellard
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom
| | - Elisa De Franco
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom
| | - Kyriaki Karavanaki
- University of Athens, 2nd Department of Pediatrics, “P&A Kyriakou” Children’s Hospital, Diabetes and Metabolism Unit, Athens, Greece,* Address for Correspondence: University of Athens, 2nd Department of Pediatrics, “P&A Kyriakou” Children’s Hospital, Diabetes and Metabolism Unit, Athens, Greece Phone: +30-210-7726488 E-mail:
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Dahl AR, Dhamija R, Nofal AA, Pittock ST, Schwenk WF, Kumar S. Transient Neonatal Diabetes due to a Mutation in KCNJ11 in a Child with Klinefelter Syndrome. J Clin Res Pediatr Endocrinol 2018; 10:79-82. [PMID: 28766502 PMCID: PMC5838377 DOI: 10.4274/jcrpe.4807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Klinefelter syndrome is the most frequent chromosomal aneuploidy in males occurring in about 1 in 660 males. Epidemiological studies have demonstrated increased risk of type 1 diabetes and type 2 diabetes in adults with Klinefelter syndrome. There is only one previous report of neonatal diabetes in a patient with Klinefelter syndrome. We report transient neonatal diabetes due to a pathogenic heterozygous variant in KCNJ11 in a male infant with Klinefelter syndrome. A 78-day old male infant was noted to have sustained hyperglycemia with serum glucose ranging between 148 mg/dL (8.2 mmol/L) and 381 mg/dL (21.2 mmol/L) three days after undergoing a complete repair of an atrioventricular defect. Hemoglobin A1c was 6.6%. The patient was born at term with a birth weight of 2.16 kg following a pregnancy complicated by gestational diabetes that was controlled with diet. The patient was initially started on a continuous intravenous insulin drip and subsequently placed on subcutaneous insulin (glargine, human isophane and regular insulin). Insulin was gradually decreased and eventually discontinued at seven months of age. Chromosomal microarray at 11 weeks of age showed XXY and a panel-based, molecular test for neonatal diabetes revealed a pathogenic heterozygous variant c.685G>A (p.Glu229Lys) in KCNJ11. The patient is now 34 months old and continues to have normal fasting and post-prandial glucose and HbA1C levels. The patient will need prospective follow up for assessment of his glycemic status. To our knowledge this is the second reported case of neonatal diabetes in an infant with Klinefelter syndrome and the first due to a mutation in the KCNJ11 in a patient with Klinefelter syndrome.
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Affiliation(s)
- Amanda R. Dahl
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota, USA
| | - Radhika Dhamija
- Mayo Clinic, Department of Clinical Genomics, Phoenix, Arizona, USA
| | - Alaa Al Nofal
- University of South Dakota, Sanford Children Specialty Clinic, Division of Pediatric Endocrinology, Sioux Falls, South Dakota, USA
| | - Siobhan T. Pittock
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA
| | - W. Frederick Schwenk
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA
| | - Seema Kumar
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA,* Address for Correspondence: Department of Pediatric and Adolescent Medicine, Division of Pediatric Endocrinology, Rochester, Minnesota, USA GSM: +507-284-3300 E-mail:
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Rabbone I, Barbetti F, Gentilella R, Mossetto G, Bonfanti R, Maffeis C, Iafusco D, Piccinno E. Insulin therapy in neonatal diabetes mellitus: a review of the literature. Diabetes Res Clin Pract 2017; 129:126-135. [PMID: 28527303 DOI: 10.1016/j.diabres.2017.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/15/2017] [Accepted: 04/07/2017] [Indexed: 10/19/2022]
Abstract
AIMS Neonatal diabetes mellitus (NDM) is a rare disorder, and guidance is limited regarding its optimal management. We reviewed insulin usage in NDM, with a focus on continuous subcutaneous insulin infusion (CSII). METHODS A PubMed search identified 40 reports of patients with NDM treated with insulin published between 1994 and 2016. RESULTS Data concerning treatment of NDM are limited. CSII resolves some of the issues associated with insulin therapy in neonates. No clinical trials of CSII in NDM have been reported. Case reports suggest that CSII is a safe and effective means of treating NDM. CSII was initiated to improve glycaemic control, for practicality and convenience, and to overcome difficulties associated with the maintenance of long-term intravenous catheters. CSII can provide better glycaemic control than multiple daily injections, with few hypoglycaemic events. Continuous glucose monitoring integrated with the pump helps provide more precise control of blood glucose levels. CSII generally uses short-acting insulin or rapid-acting insulin analogues, and those that are approved for use in neonates appear to be appropriate for the treatment of NDM using an insulin pump. CONCLUSIONS Information from case reports indicates that CSII is safe and effective for the management of NDM.
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Affiliation(s)
- Ivana Rabbone
- Department of Paediatrics, University of Turin, 10126 Turin, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, 00133 Rome, Italy; Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | | | - Riccardo Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), San Raffaele Scientific Hospital, 20132 Milan, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, 37126 Verona, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G.Stoppoloni", Department of Women, Child and General Surgery, Second University of Naples, 80138 Naples, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, 70126 Bari, Italy
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Zammit MA, Agius SM, Calleja-Agius J. Transient Neonatal Diabetes Mellitus: A Challenge and Opportunity for Specialized Nursing Care. Neonatal Netw 2017; 36:196-205. [PMID: 28764822 DOI: 10.1891/0730-0832.36.4.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transient neonatal diabetes mellitus (TNDM) is a rare disorder, with a reported incidence of approximately 1 in 450,000 live births. It is characterized by insulin-requiring hyperglycemia in the neonatal period. The disease improves by early childhood, but the patient may relapse in later life. Diagnosis is made after genetic testing following presentation with hyperglycemia not conforming to Type 1 or Type 2 diabetes. Management is based on insulin and possible sulfonylurea administration. Three genetically distinct subtypes of TNDM are recognized. Type 1 TNDM is due to overexpression of genes at the 6q24 locus, whereas the 11p15 locus is involved in Type 2 and 3 TNDM. In this article the clinical presentation, management, and genetics of TNDM are discussed, particularly emphasizing the role of the neonatal nurse.
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Rabbone I, Barbetti F, Marigliano M, Bonfanti R, Piccinno E, Ortolani F, Ignaccolo G, Maffeis C, Confetto S, Cerutti F, Zanfardino A, Iafusco D. Successful treatment of young infants presenting neonatal diabetes mellitus with continuous subcutaneous insulin infusion before genetic diagnosis. Acta Diabetol 2016; 53:559-65. [PMID: 26831749 DOI: 10.1007/s00592-015-0828-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
Abstract
AIMS Neonatal diabetes mellitus (NDM) is defined as hyperglycemia and impaired insulin secretion with onset within 6 months of birth. While rare, NDM presents complex challenges regarding the management of glycemic control. The availability of continuous subcutaneous insulin infusion pumps (CSII) in combination with continuous glucose monitoring systems (CGM) provides an opportunity to monitor glucose levels more closely and deliver insulin more safely. METHODS We report four cases of young infants with NDM successfully treated with CSII and CGM. Moreover, in two cases with Kir 6.2 mutation, we describe the use of CSII in switching therapy from insulin to sulfonylurea treatment. RESULTS Insulin pump requirement for the 4 neonatal diabetes cases was the same regardless of disease pathogenesis and c-peptide levels. No dilution of insulin was needed. The use of an integrated CGM system helped in a more precise control of BG levels with the possibility of several modifications of insulin basal rates. Moreover, as showed in the first two case-reports, when the treatment was switched from insulin to glibenclamide, according to identification of Kir 6.2 mutation and diagnosis of NPDM, the CSII therapy demonstrated to be helpful in allowing gradual insulin suspension and progressive introduction of sulfonylurea. CONCLUSIONS During the neonatal period, the use of CSII therapy is safe, more physiological, accurate and easier for the insulin administration management. Furthermore, CSII therapy is safe during the switch of therapy from insulin to glibenclamide for infants with permanent neonatal diabetes mellitus.
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Affiliation(s)
- Ivana Rabbone
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
- Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Marco Marigliano
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Riccardo Bonfanti
- Department of Pediatrics, Ospedale San Raffaele Scientific Institute, Milan, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Federica Ortolani
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Giovanna Ignaccolo
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Santino Confetto
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Franco Cerutti
- Department of Pediatrics, Regina Margherita Hospital, University of Turin, Piazza Polonia 94, Turin, Italy
| | - Angela Zanfardino
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
| | - Dario Iafusco
- Regional Center for Pediatric Diabetes "G.Stoppoloni", Department of Pediatrics, Second University of Naples, Naples, Italy
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