The potential role of intermittent continuous glucose monitoring in a successful outpatient transition from insulin to glibenclamide in a patient with transient neonatal diabetes in the context of the COVID-19 pandemic

ABSTRACT

Introduction: Neonatal diabetes mellitus (NDM) is a rare monogenic form of diabetes occurring mainly in the first 6 months of life. Approximately 30% of transient NDM cases have an activating mutation in the KATP channel genes ABCC8 and KCNJ11. The majority of transfers from insulin to sulfonylureas in patients with KCNJ11 mutations are done inside the hospital. Objectives: To report a case of transient neonatal diabetes mellitus (TNDM) where precision medicine, defining treatment based on molecular diagnosis and technology (intermittent continuous glucose monitoring-iCGM) allowed to make treatment adjustments with the patient safely at home, in times of COVID-19 pandemic. Methods: Case report of a patient with TNDM in use of iCGM. Results: A boy with transient NDM due to the p.E227K mutation in the KCNJ11 gene. Diabetes remitted at 30 months and relapsed at 6 years of age. Insulin was initiated and soon transition to glibenclamide was proposed with the use of iCGM, which allowed the patient to safely stay at home during the transition, especially important in the context of the COVID-19 pandemic. The data was uploaded to an online platform that allowed the medical team to perform remote daily checks on glucose levels and suggest treatment changes. During insulin therapy, the device's 14-day analysis revealed a glucose management index (GMI) of 7,2% and 72% of time in range (TIR). Patient's glucose profile improved rapidly after SU was initiated so that insulin therapy was discontinued. After four months of SU treatment, GMI was 6,2% with 93% of TIR (Figure 1). Conclusions: NDM is a model of a genetic disease that can benefit from precision medicine, where treatment is defined after molecular diagnosis, and that iCGM is a valuable tool that should be considered to monitor glucose, increase safety and speed up dose adjustments in outpatient transition from insulin to glibenclamide. As far as we understand the use of iCGM was not reported in this situation previously.