Abstract
We describe the sixth case reported until now of permanent diabetes not associated with serological evidence of autoimmunity in a child who developed INDM 10 yr earlier. A small for gestational age infant developed hyperglycemia at 25 days of age and required insulin therapy for the first 9 mo of life. During a 10 yr longitudinal follow-up, ICA, IAA and organ specific and non-specific autoantibodies were negative, but sequential IVGII showed a first phase insulin reponse (FPIR) < 1st centile (15-28) uU/ml) and mean HbA1c value was 6.1 ± 0.8%. Transient hyperglycemia and glucosuria were recorde at age 4 and 6.3 yr during and intercurrent illness. HLA type was DR2. At age 10 yr & 1 mo (Tanner stage 1-2)a progressive blood glucose increase was observed from 4 to 7 a.m. with a spontaneous normalisation before noon. FPIR was 12 uU/ml). Six isophane insulin units injected at 10 p.m. prevented glycemia increase. Six mo latter (FPIR = 18 uU/ml; ICA & IAA negative) & permanent insulin treatment was started. During 3 yr period preceding insulin therapy, a progressive decrease in growth velocity was observed with high stimulated GH and low IGF1 levels. With insulin therapy (0.51 ± 0.15 U/kg/day) a catch-up growth and a normalization of IGF1 were obtained. The physiological increase in insulin resistance during puberty could be at the origin of (definitive?) insulin dependence in this subject.
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Vanelli, M., Fanti, A., Cantoni, S. et al. TRANSIENT NEONATAL DIABETES MELLITUS (TNDM) AND SUBSEQUENT (10 yr later) PERRANENT IDDM UNRELATED TO AUTOIMMUNITY. Pediatr Res 33 (Suppl 5), S76 (1993). https://doi.org/10.1203/00006450-199305001-00436
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DOI: https://doi.org/10.1203/00006450-199305001-00436