D. Iafusco

No beta cell desensitisation after a median of 68 months on glibenclamide therapy in patients with KCNJ11-associated permanent neonatal diabetes.

Keywords Chronic.Durability.Efficacy.Glibenclamide.KCNJ11 gene.Kir6.2.Mutations.Permanent neonataldiabetes.Sulfonylurea.TherapyAbbreviationsDEND Developmental delay, epilepsy and neonataldiabetesiDEND Intermediate DENDTo the Editor: Patients with permanent neonatal- orinfancy-onset diabetes mellitus associated with activatingmutations of KCNJ11 and ABCC8 genes, which encodethe ATP-sensitive potassium channel of the pancreatic betacell, can be successfully weaned from insulin andtransferred to sulfonylureas [1, 2]. Individuals carryingspecific mutations of KCNJ11 or ABCC8 may present withdevelopmental delay, epilepsy and neonatal diabetes(DEND) syndrome or intermediate DEND (iDEND), i.e.may have, in additionto diabetes, motor/mental developmen-tal delay with or without epilepsy. Notably, patients withDEND may require higher doses of sulfonylureas to attainproper metabolic control [3]. Glibenclamide, a long-actingsulfonylurea largely used in the therapy of type 2 diabetes, isoften used to treat patients with neonatal- or infancy-onsetdiabetes due to KCNJ11 or ABCC8 mutations [1–4].

A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes

We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0–18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05–0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers.

Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1‐year cohort study

Insulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy.

All classifications not built on pathogenesis become inadequate sooner or later

Keywords Gestational diabetes.Glucokinase.MODY-2AbbreviationsHAPO Hyperglycemia Adverse Pregnancy OutcomeLGA Large for gestational ageSGA Small for gestational ageTo the Editor: We read with interest the paper by E. A. Ryan[1] concerning the new criteria suggested by the Hypergly-cemia Adverse Pregnancy Outcome (HAPO) study for thediagnosis of gestational diabetes [2]. Ryan showed thatapplying these criteria would result in a doubling of thenumber of pregnant women diagnosed with gestationaldiabetes without a clear demonstration of the benefitsderived from this new classification. As he observes,maternal obesity represents a stronger predictor of large-for-gestational-age (LGA) babies than glucose levels in allexcept the highest glucose category [1, 3]. This suggeststhat not all gestational hyperglycaemia has the sameaetiology. As was the case in paediatrics, where for manydecades we wrongly diagnosed all children with hyper-glycaemia as having type 1 diabetes [4], we risk includingin this generic categorisation of gestational diabetes theundetected monogenic forms that are often underdiagnosed[5, 6]. For example, in those patients belonging to thelowest glucose categories of HAPO those with MODY-2obtain no benefit from the treatment of their hyperglycae-mia. In the 11 patients with MODY-2 that we followed up

Mutations in IAPP and NEUROG3 genes are not a common cause of permanent neonatal/infancy/childhood-onset diabetes

1 Heinzerling L, Raile K, Rochlitz H, Zuberbier T, Worm M. Insulin allergy: clinical manifestations and management strategies. Allergy 2008; 63: 148–155. 2 Greenfield JR, Tuthill A, Soos MA, Semple RK, Halsall DJ, Chaudhry A et al. Severe insulin resistance due to anti-insulin antibodies: response to plasma exchange and immunosuppressive therapy. Diabet Med 2009; 26: 79–82. 3 Shemin D, Briggs D, Greenan M. Complications of therapeutic plasma exchange: a prospective study of 1,727 procedures. J Clin Apher 2007; 22: 270–276. 4 Nicholls AJ, Platts MM. Anaphylactoid reactions due to haemodialysis, haemofiltration, or membrane plasma separation. Br Med J (Clin Res Ed) 1982; 285: 1607–1609.

Comparative Efficacy of iBGStar Glucose Meter vs. A Traditional Glucose Meter in Type 1 Diabetes

Background: Optimal metabolic control and compliance to self-monitoring of blood glucose (SMBG) are poor in adolescents and young adults with type 1 diabetes mellitus (T1DM), and may require innovative management strategies. These may include the use of telemedicine and smartphone-linked blood glucose self-monitoring systems. To this purpose, a specific glucose meter (iBGStar™) and a dedicated Diabetes Manager Application (DMApp) have been developed. Aim of the study is to demonstrate the superiority of a smartphone-linked versus a traditional self-monitoring system in reducing HbA1c levels and improving compliance to SMBG. Methods/Design: The “i-NewTrend” study is an open-label, randomized (1:1) trial involving 21 diabetes outpatient clinics in Italy. Overall, 178 subjects aged 14–24 years with type 1 diabetes, with any diabetes duration, HbA1c ≥8%, treated with basal-bolus insulin regimen, and with poor compliance with SMBG will be randomized to two different SMBG strategies: Group A will use iBGStar™+ DMApp and Group B (control group) will use a traditional meter for SMBG during a 6-month follow-up (experimental phase). Between-group differences on metabolic control, compliance to SMBG, insulin doses, quality of life, risk of hypoglicaemic episodes and number and type of contacts with diabetes clinics will be evaluated. During a 6 month post-trial observational phase, all randomized patients in group A and B will use iBGStar™ + DMApp to evaluate the impact of the system on all the outcomes when the system is used under routine clinical practice conditions. Discussion: Results of the trial iNew Trend will assess whether and to what extent this new strategy of SMBG based on the use of iBGStar™ + DMApp will improve the management of type 1 diabetes in adolescents and young adults poorly controlled and poorly compliant, both in experimental and usual care settings.