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Bowman P, Mathews F, Barbetti F, Shepherd MH, Sanchez J, Piccini B, Beltrand J, Letourneau-Freiberg LR, Polak M, Greeley SAW, Rawlins E, Babiker T, Thomas NJ, De Franco E, Ellard S, Flanagan SE, Hattersley AT. Long-term Follow-up of Glycemic and Neurological Outcomes in an International Series of Patients With Sulfonylurea-Treated ABCC8 Permanent Neonatal Diabetes. Diabetes Care 2021; 44:35-42. [PMID: 33184150 PMCID: PMC7783935 DOI: 10.2337/dc20-1520] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE ABCC8 mutations cause neonatal diabetes mellitus that can be transient (TNDM) or, less commonly, permanent (PNDM); ∼90% of individuals can be treated with oral sulfonylureas instead of insulin. Previous studies suggested that people with ABCC8-PNDM require lower sulfonylurea doses and have milder neurological features than those with KCNJ11-PNDM. However, these studies were short-term and included combinations of ABCC8-PNDM and ABCC8-TNDM. We aimed to assess the long-term glycemic and neurological outcomes in sulfonylurea-treated ABCC8-PNDM. RESEARCH DESIGN AND METHODS We studied all 24 individuals with ABCC8-PNDM diagnosed in the U.K., Italy, France, and U.S. known to transfer from insulin to sulfonylureas before May 2010. Data on glycemic control, sulfonylurea dose, adverse effects including hypoglycemia, and neurological features were analyzed using nonparametric statistical methods. RESULTS Long-term data were obtained for 21 of 24 individuals (median follow-up 10.0 [range 4.1-13.2] years). Eighteen of 21 remained on sulfonylureas without insulin at the most recent follow-up. Glycemic control improved on sulfonylureas (presulfonylurea vs. 1-year posttransfer HbA1c 7.2% vs. 5.7%, P = 0.0004) and remained excellent long-term (1-year vs. 10-year HbA1c 5.7% vs. 6.5%, P = 0.04), n = 16. Relatively high doses were used (1-year vs. 10-year dose 0.37 vs. 0.25 mg/kg/day glyburide, P = 0.50) without any severe hypoglycemia. Neurological features were reported in 13 of 21 individuals; these improved following sulfonylurea transfer in 7 of 13. The most common features were learning difficulties (52%), developmental delay (48%), and attention deficit hyperactivity disorder (38%). CONCLUSIONS Sulfonylurea treatment of ABCC8-PNDM results in excellent long-term glycemic control. Overt neurological features frequently occur and may improve with sulfonylureas, supporting early, rapid genetic testing to guide appropriate treatment and neurodevelopmental assessment.
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Affiliation(s)
- Pamela Bowman
- Exeter NIHR Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K.
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Frances Mathews
- Exeter NIHR Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Fabrizio Barbetti
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
- Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maggie H Shepherd
- Exeter NIHR Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, U.K
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Janine Sanchez
- Miller School of Medicine, University of Miami, Miami, FL
| | - Barbara Piccini
- Regional Center for Pediatric Diabetes, Meyer University Children's Hospital, Florence, Italy
| | - Jacques Beltrand
- Service d'Endocrinologie, Gynécologie et Diabétologie Pédaitrique, APHP Centre, Université de Paris, Paris, France
- INSERM U1016, Paris, France
- Institut IMAGINE, Paris, France
| | | | - Michel Polak
- Service d'Endocrinologie, Gynécologie et Diabétologie Pédaitrique, APHP Centre, Université de Paris, Paris, France
- INSERM U1016, Paris, France
- Institut IMAGINE, Paris, France
| | | | - Eamon Rawlins
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Tarig Babiker
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Nicholas J Thomas
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
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Patel KA, Knight B, Aziz A, Babiker T, Tamar A, Findlay J, Cox S, Dimitropoulos I, Tysoe C, Panicker V, Vaidya B. Utility of systematic TSHR gene testing in adults with hyperthyroidism lacking overt autoimmunity and diffuse uptake on thyroid scintigraphy. Clin Endocrinol (Oxf) 2019; 90:328-333. [PMID: 30372544 PMCID: PMC6378592 DOI: 10.1111/cen.13892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients with hyperthyroidism lacking autoimmune features but showing diffuse uptake on thyroid scintigram can have either Graves' disease or germline activating TSH receptor (TSHR) mutation. It is important to identify patients with activating TSHR mutation due to treatment implication, but the overlapping clinical features with Graves' disease make it difficult to discriminate these two conditions without genetic testing. Our study aimed to assess the potential of systematic TSHR mutation screening in adults with hyperthyroidism, showing diffuse uptake on thyroid scintigraphy but absence of TSH receptor antibodies (TRAb) and clinical signs of autoimmunity. DESIGN A cross-sectional study of Caucasian adults with hyperthyroidism, managed at three endocrine centres in the South West, UK, from January 2006 to April 2017. METHODS We recruited 78 adult Caucasian patients with hyperthyroidism showing diffuse uptake on 99m Tc-pertechnetate thyroid scintigraphy but without TRAb and other autoimmune clinical features of Graves' disease (such as thyroid-associated ophthalmopathy or dermopathy). Genomic DNA of these patients was analysed for variants in the TSHR gene. RESULTS Genetic analysis identified 11 patients with four variants in TSHR [p.(Glu34Lys), p.(Asp36His), p.(Pro52Thr) and p.(Ile334Thr)]. None of these variants were pathogenic according to the American College of Medical Genetics and Genomics guideline. CONCLUSIONS Activating TSHR mutations are a rare cause of nonautoimmune adult hyperthyroidism. Our study does not support the routine genetic testing in adult patients with hyperthyroidism showing diffuse uptake on scintigraphy but negative TRAb and lacking extrathyroidal manifestations of Graves' disease.
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Affiliation(s)
- Kashyap A. Patel
- The Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
- Department of Diabetes and EndocrinologyThe Royal Devon and Exeter NHS Foundation TrustExeterUK
| | - Bridget Knight
- The Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
- NIHR Clinical Research Facility, R&D DepartmentThe Royal Devon and Exeter NHS Foundation trustExeterUK
| | - Aftab Aziz
- Department of Diabetes and EndocrinologyUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - Tarig Babiker
- Department of Diabetes and EndocrinologyUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - Avades Tamar
- Department of Diabetes and EndocrinologyThe Royal Devon and Exeter NHS Foundation TrustExeterUK
| | - Joanna Findlay
- NIHR Clinical Research Facility, R&D DepartmentThe Royal Devon and Exeter NHS Foundation trustExeterUK
| | - Sue Cox
- Department of Diabetes and Endocrinology, Torbay and South DevonNHS Foundation TrustTorbayUK
| | - Ioannis Dimitropoulos
- Department of Diabetes and EndocrinologyUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - Carolyn Tysoe
- Department of Molecular GeneticsThe Royal Devon and Exeter NHS Foundation TrustExeterUK
| | - Vijay Panicker
- Department of EndocrinologySir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Bijay Vaidya
- The Institute of Biomedical and Clinical ScienceUniversity of Exeter Medical SchoolExeterUK
- Department of Diabetes and EndocrinologyThe Royal Devon and Exeter NHS Foundation TrustExeterUK
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Bowman P, Sulen Å, Barbetti F, Beltrand J, Svalastoga P, Codner E, Tessmann EH, Juliusson PB, Skrivarhaug T, Pearson ER, Flanagan SE, Babiker T, Thomas NJ, Shepherd MH, Ellard S, Klimes I, Szopa M, Polak M, Iafusco D, Hattersley AT, Njølstad PR. Effectiveness and safety of long-term treatment with sulfonylureas in patients with neonatal diabetes due to KCNJ11 mutations: an international cohort study. Lancet Diabetes Endocrinol 2018; 6:637-646. [PMID: 29880308 PMCID: PMC6058077 DOI: 10.1016/s2213-8587(18)30106-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 03/22/2018] [Accepted: 03/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND KCNJ11 mutations cause permanent neonatal diabetes through pancreatic ATP-sensitive potassium channel activation. 90% of patients successfully transfer from insulin to oral sulfonylureas with excellent initial glycaemic control; however, whether this control is maintained in the long term is unclear. Sulfonylurea failure is seen in about 44% of people with type 2 diabetes after 5 years of treatment. Therefore, we did a 10-year multicentre follow-up study of a large international cohort of patients with KCNJ11 permanent neonatal diabetes to address the key questions relating to long-term efficacy and safety of sulfonylureas in these patients. METHODS In this multicentre, international cohort study, all patients diagnosed with KCNJ11 permanent neonatal diabetes at five laboratories in Exeter (UK), Rome (Italy), Bergen (Norway), Paris (France), and Krakow (Poland), who transferred from insulin to oral sulfonylureas before Nov 30, 2006, were eligible for inclusion. Clinicians collected clinical characteristics and annual data relating to glycaemic control, sulfonylurea dose, severe hypoglycaemia, side-effects, diabetes complications, and growth. The main outcomes of interest were sulfonylurea failure, defined as permanent reintroduction of daily insulin, and metabolic control, specifically HbA1c and sulfonylurea dose. Neurological features associated with KCNJ11 permanent neonatal diabetes were also assessed. This study is registered with ClinicalTrials.gov, number NCT02624817. FINDINGS 90 patients were identified as being eligible for inclusion and 81 were enrolled in the study and provided long-term (>5·5 years cut-off) outcome data. Median follow-up duration for the whole cohort was 10·2 years (IQR 9·3-10·8). At most recent follow-up (between Dec 1, 2012, and Oct 4, 2016), 75 (93%) of 81 participants remained on sulfonylurea therapy alone. Excellent glycaemic control was maintained for patients for whom we had paired data on HbA1c and sulfonylurea at all time points (ie, pre-transfer [for HbA1c], year 1, and most recent follow-up; n=64)-median HbA1c was 8·1% (IQR 7·2-9·2; 65·0 mmol/mol [55·2-77·1]) before transfer to sulfonylureas, 5·9% (5·4-6·5; 41·0 mmol/mol [35·5-47·5]; p<0·0001 vs pre-transfer) at 1 year, and 6·4% (5·9-7·3; 46·4 mmol/mol [41·0-56·3]; p<0·0001 vs year 1) at most recent follow-up (median 10·3 years [IQR 9·2-10·9]). In the same patients, median sulfonylurea dose at 1 year was 0·30 mg/kg per day (0·14-0·53) and at most recent follow-up visit was 0·23 mg/kg per day (0·12-0·41; p=0·03). No reports of severe hypoglycaemia were recorded in 809 patient-years of follow-up for the whole cohort (n=81). 11 (14%) patients reported mild, transient side-effects, but did not need to stop sulfonylurea therapy. Seven (9%) patients had microvascular complications; these patients had been taking insulin longer than those without complications (median age at transfer to sulfonylureas 20·5 years [IQR 10·5-24·0] vs 4·1 years [1·3-10·2]; p=0·0005). Initial improvement was noted following transfer to sulfonylureas in 18 (47%) of 38 patients with CNS features. After long-term therapy with sulfonylureas, CNS features were seen in 52 (64%) of 81 patients. INTERPRETATION High-dose sulfonylurea therapy is an appropriate treatment for patients with KCNJ11 permanent neonatal diabetes from diagnosis. This therapy is safe and highly effective, maintaining excellent glycaemic control for at least 10 years. FUNDING Wellcome Trust, Diabetes UK, Royal Society, European Research Council, Norwegian Research Council, Kristian Gerhard Jebsen Foundation, Western Norway Regional Health Authority, Southern and Eastern Norway Regional Health Authority, Italian Ministry of Health, Aide aux Jeunes Diabetiques, Societe Francophone du Diabete, Ipsen, Slovak Research and Development Agency, and Research and Development Operational Programme funded by the European Regional Development Fund.
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Affiliation(s)
| | - Åsta Sulen
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | | | - Jacques Beltrand
- Service Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Universitaire Necker Enfants Malades Paris, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes-Université Sorbonne Paris Cité, Inserm U1016, Institut Imagine, Paris, France
| | - Pernille Svalastoga
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | - Ethel Codner
- Institute for Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | | | - Petur B Juliusson
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
| | | | - Ewan R Pearson
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | | | | | | | - Maggie H Shepherd
- University of Exeter Medical School, Exeter, UK; Exeter NIHR Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sian Ellard
- University of Exeter Medical School, Exeter, UK
| | - Iwar Klimes
- Biomedical Research Centre, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Magdalena Szopa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Michel Polak
- Service Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Universitaire Necker Enfants Malades Paris, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Descartes-Université Sorbonne Paris Cité, Inserm U1016, Institut Imagine, Paris, France
| | - Dario Iafusco
- Department of Paediatrics, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Pål R Njølstad
- KG Jebsen Centre for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Paediatrics and Adolescents, Haukeland University Hospital, Bergen, Norway
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Babiker T, Kyrodimou E, Berney DM, Gurnell M, Drake WM, Brooke A. Acromegaly and Cushing's syndrome caused by a neuroendocrine tumor arising within a sacrococcygeal teratoma. Clin Case Rep 2017; 5:1768-1771. [PMID: 29152267 PMCID: PMC5676263 DOI: 10.1002/ccr3.1148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/27/2017] [Accepted: 07/20/2017] [Indexed: 11/05/2022] Open
Abstract
A 60-year-old man with a pre-existing stable sacrococcygeal teratoma developed acromegaly, ectopic Cushing's syndrome, and 5HIAA secretion. To our knowledge, this represents the first reported case of ACTH and serotonin secretion, and likely GHRH or GH cosecretion, from a sacrococcygeal teratoma in an adult.
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Affiliation(s)
- Tarig Babiker
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
| | - Efstathia Kyrodimou
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
| | - Daniel M Berney
- Department of Histopathology Barts Cancer Institute Queen Mary, University of London London EC1A7BE UK
| | - Mark Gurnell
- Metabolic Research Laboratories Wellcome Trust-MRC Institute of Metabolic Science National Institute for Health Research Cambridge Biomedical Research Centre Addenbrooke's Hospital University of Cambridge Cambridge CB2 0QQ UK
| | - William M Drake
- Department of Endocrinology St Bartholomew's Hospital London EC1A7BE UK
| | - Antonia Brooke
- Departments of Endocrinology and Histopathology Royal Devon and Exeter Hospital Barrack Road Exeter EX2 5DW UK
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McDonald TJ, Besser RE, Perry M, Babiker T, Knight BA, Shepherd MH, Ellard S, Flanagan SE, Hattersley AT. Screening for neonatal diabetes at day 5 of life using dried blood spot glucose measurement. Diabetologia 2017; 60:2168-2173. [PMID: 28779213 PMCID: PMC5907681 DOI: 10.1007/s00125-017-4383-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/23/2017] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The majority of infants with neonatal diabetes mellitus present with severe ketoacidosis at a median of 6 weeks. The treatment is very challenging and can result in severe neurological sequelae or death. The genetic defects that cause neonatal diabetes are present from birth. We aimed to assess if neonatal diabetes could be diagnosed earlier by measuring glucose in a dried blood spot collected on day 5 of life. METHODS In this retrospective case-control study we retrieved blood spot cards from 11 infants with genetically confirmed neonatal diabetes (median age of diagnosis 6 [range 2-112] days). For each case we also obtained one (n = 5) or two (n = 6) control blood spot cards collected on the same day. Glucose was measured on case and control blood spot cards. We established a normal range for random glucose at day 5 of life in 687 non-diabetic neonates. RESULTS All 11 neonates with diabetes had hyperglycaemia present on day 5 of life, with blood glucose levels ranging from 10.2 mmol/l to >30 mmol/l (normal range 3.2-6.0 mmol/l). In six of these neonates the diagnosis of diabetes was made after screening at day 5, with the latest diagnosis made at 16 weeks. CONCLUSIONS/INTERPRETATION Neonatal diabetes can be detected on day 5 of life, preceding conventional diagnosis in most cases. Earlier diagnosis by systematic screening could lead to prompt genetic diagnosis and targeted treatment, thereby avoiding the most severe sequelae of hyperglycaemia in neonates.
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Affiliation(s)
- Timothy J McDonald
- Blood Sciences, Template A2, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK.
| | - Rachel E Besser
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Mandy Perry
- Blood Sciences, Template A2, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Tarig Babiker
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK
| | - Bridget A Knight
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK
| | - Maggie H Shepherd
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Andrew T Hattersley
- National Institute for Health Research (NIHR) Exeter Clinical Research Facility, University of Exeter, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
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Babiker T, Vedovato N, Patel K, Thomas N, Finn R, Männikkö R, Chakera AJ, Flanagan SE, Shepherd MH, Ellard S, Ashcroft FM, Hattersley AT. Successful transfer to sulfonylureas in KCNJ11 neonatal diabetes is determined by the mutation and duration of diabetes. Diabetologia 2016; 59:1162-6. [PMID: 27033559 PMCID: PMC4869695 DOI: 10.1007/s00125-016-3921-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/17/2016] [Indexed: 10/29/2022]
Abstract
AIMS/HYPOTHESIS The finding that patients with diabetes due to potassium channel mutations can transfer from insulin to sulfonylureas has revolutionised the management of patients with permanent neonatal diabetes. The extent to which the in vitro characteristics of the mutation can predict a successful transfer is not known. Our aim was to identify factors associated with successful transfer from insulin to sulfonylureas in patients with permanent neonatal diabetes due to mutations in KCNJ11 (which encodes the inwardly rectifying potassium channel Kir6.2). METHODS We retrospectively analysed clinical data on 127 patients with neonatal diabetes due to KCNJ11 mutations who attempted to transfer to sulfonylureas. We considered transfer successful when patients completely discontinued insulin whilst on sulfonylureas. All unsuccessful transfers received ≥0.8 mg kg(-1) day(-1) glibenclamide (or the equivalent) for >4 weeks. The in vitro response of mutant Kir6.2/SUR1 channels to tolbutamide was assessed in Xenopus oocytes. For some specific mutations, not all individuals carrying the mutation were able to transfer successfully; we therefore investigated which clinical features could predict a successful transfer. RESULTS In all, 112 out of 127 (88%) patients successfully transferred to sulfonylureas from insulin with an improvement in HbA1c from 8.2% (66 mmol/mol) on insulin, to 5.9% (41 mmol/mol) on sulphonylureas (p = 0.001). The in vitro response of the mutation to tolbutamide determined the likelihood of transfer: the extent of tolbutamide block was <63% for the p.C166Y, p.I296L, p.L164P or p.T293N mutations, and no patients with these mutations successfully transferred. However, most individuals with mutations for which tolbutamide block was >73% did transfer successfully. The few patients with these mutations who could not transfer had a longer duration of diabetes than those who transferred successfully (18.2 vs 3.4 years, p = 0.032). There was no difference in pre-transfer HbA1c (p = 0.87), weight-for-age z scores (SD score; p = 0.12) or sex (p = 0.17). CONCLUSIONS/INTERPRETATION Transfer from insulin is successful for most KCNJ11 patients and is best predicted by the in vitro response of the specific mutation and the duration of diabetes. Knowledge of the specific mutation and of diabetes duration can help predict whether successful transfer to sulfonylureas is likely. This result supports the early genetic testing and early treatment of patients with neonatal diabetes aged under 6 months.
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Affiliation(s)
- Tarig Babiker
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Natascia Vedovato
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK
| | - Kashyap Patel
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Nicholas Thomas
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Roisin Finn
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Roope Männikkö
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK
- UCL Institute of Neurology, MRC Centre for Neuromuscular Diseases, London, UK
| | - Ali J Chakera
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
- Department of Diabetes and Endocrinology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Maggie H Shepherd
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Sian Ellard
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK
| | - Frances M Ashcroft
- Department of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, Oxford, OX1 3PT, UK.
| | - Andrew T Hattersley
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5DW, UK.
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Babiker T, Chakera AJ, Shepherd M, Hattersley AT. A diagnostic approach for defining idiopathic remitting diabetes: a retrospective cohort study. BMC Endocr Disord 2014; 14:45. [PMID: 24909320 PMCID: PMC4064804 DOI: 10.1186/1472-6823-14-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 05/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 11 patients were referred to our Molecular Genetics Department at the Royal Devon and Exeter Hospital between 2000-2012 with a physician's diagnosis of remitting diabetes. Our aim was to identify patients with remitting diabetes whose clinical presentation is not explained by any known aetiology of diabetes. METHODS We obtained longitudinal clinical data on all 11 patients from the hospital records. All patients were aged between 0.5 and 35 years at diagnosis. We applied clinical criteria derived from the literature to establish 1) definite diabetes, 2) diabetes initially severe-requiring treatment with insulin, 3) remission of diabetes, and 4) exclusion of known causes of remitting diabetes. RESULTS 10 out of 11 patients had an alternative explanation for their remission or a clear diagnosis was not identified. We identified a single patient with idiopathic remitting diabetes using these criteria. The patient was a white Caucasian female diagnosed aged 15 with symptoms of diabetes, laboratory glucose of 21.2 mmol/L and HbA1c 134 mmol/mol. Her BMI was 23.6 kg/m2. She was treated with basal bolus insulin but discontinued two years after diagnosis due to hypoglycaemia. 13 years post diagnosis, she had a normal oral glucose tolerance test during pregnancy (fasting glucose 4.5 mmol/L, 2 hr glucose 4.8 mmol/L) and an HbA1c of 30 mmol/mol. This patient does not appear to have Type 1 or Type 2 diabetes, and furthermore does not fit into current classifications of diabetes. CONCLUSIONS Idiopathic remitting diabetes is rare but does exist. Strict clinical criteria are important to ensure patients have a robust clinical diagnosis. Identification of more patients with idiopathic remitting diabetes will enable further study of the clinical course of this syndrome. Applying these strict criteria will allow the identification of patients with remitting diabetes to assess its aetiology.
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Affiliation(s)
- Tarig Babiker
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Ali J Chakera
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Maggie Shepherd
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
| | - Andrew T Hattersley
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Barrack Road, Exeter EX2 5DW, UK
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Babiker T, Shepherd MH, Hattersley AT. Continue with long term sulfonylureas in patients with mutations in the KCNJ11 gene when there is evidence of response even if insulin treatment is still required. Diabetes Res Clin Pract 2013; 100:e63. [PMID: 23608551 DOI: 10.1016/j.diabres.2013.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 03/25/2013] [Indexed: 11/23/2022]
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Hamilton AJ, Babiker T. The detox diaries. Assoc Med J 2006. [DOI: 10.1136/sbmj.0610386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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