Safety and Efficacy of Using Advanced Hybrid Closed Loop Off-Label in an Infant Diagnosed with Permanent Neonatal Diabetes Mellitus: A Case Report and a Look to the Future.

IF 2 4区 医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-10-09 DOI:10.3390/children11101225
Federico Pezzotta, Nicola Sarale, Giordano Spacco, Giacomo Tantari, Enrica Bertelli, Giulia Bracciolini, Andrea Secco, Giuseppe d'Annunzio, Mohamad Maghnie, Nicola Minuto, Marta Bassi
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Abstract

The case report shows the safety and efficacy of insulin treatment with Advanced Hybrid Closed Loop (AHCL) system in a young patient affected by permanent neonatal diabetes mellitus (PNDM) due to chromosome 8 deletion syndrome involving the GATA4 gene. In the first days of life, he presented hyperglycaemia and started an intravenous insulin infusion therapy, replaced by a continuous subcutaneous insulin infusion (CSII) with Medtronic Minimed 780G® insulin pump (Medtronic, Northridge, CA, USA). At the age of 2 years, the off-label activation of SmartGuard® automated insulin delivery mode led to a great improvement in glycaemic control, reaching all recommended targets. At the 1-month follow-up visit, Time in Range (TIR) increased from 66% to 79%, with a Time in Tight Range (TTIR) of 55% and a reduction of 11% in time in hyperglycaemia and of 2% in time in hypoglycaemia. During the entire follow-up, no episodes of ketoacidosis or severe hypoglycaemia were observed and the patient maintained the glycaemic recommended targets reached at 1 month. Maintaining optimal glycaemic control and reducing hyperglycaemia are essential for brain growth and neurocognitive development in young patients. AHCL use should be considered to ensure good glycaemic control in patients affected by neonatal diabetes.

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对确诊患有永久性新生儿糖尿病的婴儿在标签外使用高级混合闭环疗法的安全性和有效性:病例报告与未来展望。
本病例报告显示,在一名因 GATA4 基因 8 号染色体缺失综合征而患永久性新生儿糖尿病(PNDM)的年轻患者身上,先进混合闭环(AHCL)系统的胰岛素治疗具有安全性和有效性。在出生后的最初几天,他出现了高血糖,并开始接受静脉胰岛素输注治疗,之后改用美敦力 Minimed 780G® 胰岛素泵(美敦力,美国加利福尼亚州北岭市)进行持续皮下胰岛素输注(CSII)。2 岁时,在标签外启用 SmartGuard® 自动胰岛素给药模式后,血糖控制得到极大改善,达到了所有推荐目标。在 1 个月的随访中,在量程内的时间(TIR)从 66% 增加到 79%,在严格量程内的时间(TTIR)为 55%,高血糖时间减少了 11%,低血糖时间减少了 2%。在整个随访过程中,没有观察到酮症酸中毒或严重低血糖的发生,患者在 1 个月时保持了建议的血糖目标。保持最佳的血糖控制和降低高血糖对年轻患者的大脑生长和神经认知发育至关重要。应考虑使用 AHCL 来确保新生儿糖尿病患者得到良好的血糖控制。
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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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