ESPE Abstracts

Background: Permanent neonatal diabetes mellitus (PNDM) is a persistent hyperglycaemia diagnosed within the first 6 months of life. A correct genetic diagnosis can affect treatment and clinical outcome. Clinical manifestations at the time of diagnosis include intrauterine growth retardation, hyperglycemia, glycosuria, osmotic polyuria, severe dehydration and failure to thrive. Insulin production is inadequate, requiring exogenous insulin therapy. The treatment corrects the hyperglycemia and results in improvement of growth. However, there are no studies reporting the longitudinal growth of these infants (head circumference, length and weight gain) after starting insulin therapy.

Aim of the study: Was to measure linear growth parameters in infants with PNDM on insulin therapy during their infancy period.

Patients and methods: Growth parameters: weight (Wt), Length (L) and head circumference (HC) were assessed in nine infants with PNDM during the first 2 years of their postnatal life. Five infants were on insulin pump therapy (CSII) and four infants were on multiple daily injections (MDI) therapy.

Results: After 20±4 months of insulin therapy a growth catch-up occurred in the majority of them. L standard deviation score (S.D.S.) increased from −1.45 to −0.65, HCSDS increased from −2.3 to −0.51 and WtSDS increased from −1.94 to −0.7, after starting insulin therapy, at the end of the 20±4 months of age. Two out of 9 infants had a LSDS <−2, in 4 WtSDS was < −2 and 1 the HCSDS was <−2 at ±4 months of postnatal growth. Growth parameters in infants on CSII therapy were better than those on MDI therapy. The mean level of HbA1C was non-significantly lower in the CSII group versus the MDI group (9.6±1% vs 10.3±2%; p: ns).

Conclusions: The majority of infants with PNDM exhibit significant good catch up growth within the first two years of life irrespective of the etiology of their neonatal diabetes. Further studies are needed to confirm our preliminary observations and to explain the persistent slow growth parameters in some of them in spite of insulin treatment.