Neonatal Diabetes Mellitus in a Resource-Limited Setting: Clinical Spectrum, Genetic Heterogeneity, Impact of Malnutrition, and Outcomes with Simplified Basal Insulin Therapy
Authors' conclusion
Genetic testing provides essential precision-medicine guidance for NDM management despite a 42.9% diagnostic yield limited by current gene panels. This series expands the NARS2-associated NDM phenotypic spectrum and demonstrates that simplified basal-only NPH insulin regimens achieve excellent outcomes in IUGR neonates while enabling exclusive breastfeeding. Pragmatic strategies optimized for resource-limited settings enable equitable, high-quality NDM care.
Study context
- Population
- Infants with insulin-dependent hyperglycemia diagnosed within 6 months of life (neonatal DM), tertiary care centre in a resource-limited region
- Participants
- 7 consecutive infants
- Outcome
- Time to glycemic control (blood glucose 100-180 mg/dL for ≥24 h on stable therapy)
Methodological detailssystematic prospective data collection, consecutive infants, single tertiary care centre
- Systematic prospective data collection
- Consecutive infants
- Single tertiary care centre
Main finding
As reported in the abstract
Identified genetic mutations (two GCK, one homozygous NARS2 variant of uncertain significance)
3 of 7
42.9%
Genetically unsolved
4
57.1%
Delayed control with severe malnutrition plus metabolic acidosis (strongest independent predictor)
40 days vs. 5-7 days
Observational data: associations, not effects.
Further findings
NARS2 case with severe intrauterine growth restriction (IUGR) (birth weight 1.5 kg) and hyperglycemia (640 mg/dL)
- Glycemic control with Neutral Protamine Hagedorn (NPH) insulin monotherapy without mealtime boluses, enabling exclusive breastfeeding
- 7 days
Provisional ABCC8 variant (ARMS PCR)
- Unsolved cases initially given glibenclamide; variant reclassified benign on whole exome sequencing, SU discontinued
- 3
Original publication
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