Ambulatório de Diabetes, Unidade de Endocrinologia Pediátrica, Departamento de Pediatria, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil.
Divisão de Endocrinologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil.
Arch Endocrinol Metab. 2022 May 25;66(3):429-435. doi: 10.20945/2359-3997000000484.
Neonatal diabetes mellitus (NDM) is a monogenic form of diabetes occurring mainly in the first 6 months of life. Approximately 30% of transient NDM (TNDM) cases will have an activating mutation in the K channel genes and . The majority of the patients with mutations who are receiving insulin treatment can be transferred to treatment with sulfonylurea (SU), with an improvement in metabolic control and quality of life. Intermittent continuous glucose monitoring (iCGM) is used to assess the current and retrospective interstitial glucose, providing information such as hypo/hyperglycemia tendency and time on target. This case report describes the use of iCGM in the transition from insulin treatment to glibenclamide in a patient with TNDM caused by a pathogenic variant of . This is the first report of a successful outpatient transition from insulin to glibenclamide, in a Brazilian child with TNDM using iCGM (FreeStyle Libre@). The remote monitoring and online management allowed the patient to safely stay at home during the transition from insulin to SU, especially important in the context of the COVID-19 pandemic. We conclude that iCGM is a helpful tool in cases of NDM and should be used to increase safety and speed up dose adjustments in outpatient transition from insulin to glibenclamide.
新生儿糖尿病（NDM）是一种主要发生在生命前 6 个月的单基因糖尿病形式。大约 30%的短暂性 NDM（TNDM）病例会在 K 通道基因 和 中出现激活突变。大多数接受胰岛素治疗的 突变患者可以改用磺脲类药物（SU）治疗，从而改善代谢控制和生活质量。间歇性连续血糖监测（iCGM）用于评估当前和回顾性间质葡萄糖，提供低血糖/高血糖倾向和目标时间等信息。本病例报告描述了在一名因 致病性变异而导致 TNDM 的患者中，使用 iCGM 从胰岛素治疗过渡到格列本脲的情况。这是首例使用 iCGM（FreeStyle Libre@）在巴西 TNDM 儿童中成功从胰岛素转为格列本脲的门诊病例。远程监测和在线管理使患者在从胰岛素转为 SU 的过程中能够安全地在家中停留，这在 COVID-19 大流行期间尤为重要。我们得出结论，iCGM 是 NDM 病例的有用工具，应在从胰岛素转为格列本脲的门诊过渡中使用，以提高安全性并加快剂量调整。
