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Sulfonylurea challenge test in subjects diagnosed with type 1 diabetes mellitus.
Citation | “Sulfonylurea Challenge Test In Subjects Diagnosed With Type 1 Diabetes Mellitus.”. Pediatric Diabetes, pp. 777-784. . |
Center | Washington University in St Louis |
Author | Maria S Remedi, Mareen Thomas, Colin G Nichols, Bess A Marshall |
Keywords | diabetes mellitus, neonatal diabetes, Sulfonylurea, treatment, type 1 diabetes |
Abstract |
BACKGROUND: Patients with early onset diabetes because of defects in glucose-stimulated insulin secretion (GSIS) may respond better to sulfonylureas than insulin treatment. Such patients include those with monogenic disorders, who can be differentiated from autoimmune type 1 diabetes mellitus (T1DM) by genetic testing. Genetic testing is expensive and unknown defects in GSIS would not be diagnosed. AIMS: We propose a sulfonylurea challenge test to identify patients who have been clinically diagnosed with T1DM, but those who maintain a preferentially sulfonylurea-responsive insulin secretion. MATERIALS & METHODS: A total of 3 healthy controls, 2 neonatal diabetes mellitus (NDM) subjects, 3 antibody-positive (Ab+T1DM), and 12 antibody-negative (Ab-T1DM) subjects with type 1 diabetes, were given an intravenous bolus of glucose followed by an oral dose of glipizide. RESULTS: Healthy controls showed a robust C-peptide increase after both glucose and glipizide, but NDM subjects showed a large increase in C-peptide only following glipizide. As expected, 2 of 3 Ab+T1DM, as well as 11 of 12 Ab-T1DM showed no response to either glucose or glipizide. However, 1 Ab-T1DM and 1 Ab+T1DM showed a small C-peptide response to glucose and a marked positive response to glipizide, suggesting defects in GSIS rather than typical autoimmune diabetes. DISCUSSION: These data demonstrate the feasibility of the sulfonylurea challenge test, and suggest that responder individuals may be identified. CONCLUSIONS: We propose that this sulfonylurea challenge test should be explored more extensively, as it may prove useful as a clinical and scientific tool. |
Year of Publication |
2017
|
Journal |
Pediatric diabetes
|
Volume |
18
|
Issue |
8
|
Number of Pages |
777-784
|
Date Published |
12/2017
|
ISSN Number |
1399-5448
|
DOI |
10.1111/pedi.12489
|
Alternate Journal |
Pediatr Diabetes
|
PMID |
28111849
|
PMCID |
PMC5522783
|
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