Introduction:
Diabetes is a common disorder that affects millions of people. Most adults get diagnosed with diabetes in their 40s which is called Type 2 diabetes. Some children get diabetes in their childhood, called type 1 diabetes or juvenile diabetes. Apart from this, newborn babies can also get diabetes soon after birth. This type of diabetes is called neonatal diabetes. It is of two types: transient and permanent. Transient diabetes mellitus in the newborn (TNDM) typically resolves after a few months, whereas permanent diabetes mellitus in the newborn lasts for the rest of the child's life.
What Is Transient Diabetes Mellitus of the Newborn?
Transient diabetes mellitus of the newborn or transient neonatal diabetes mellitus is a type of neonatal diabetes that occurs temporarily for a short period of time in newborns. Neonatal diabetes is not very common and affects only one in 100,000 newborns. Research has shown that transient diabetes Mellitus of the newborn accounts for one-half of total neonatal diabetes. It appears in newborns within six months of age, and although it subsides during infancy, it may reoccur during adolescence or adulthood.
What Are the Causes of Transient Diabetes Mellitus in the Newborn?
Transient diabetes mellitus of the newborn is a genetic disorder, and mutation in some genes is responsible for its occurrence. Some recent studies have shown the majority of the transient diabetes mellitus of a newborn is caused by mutations in the gene, such as ATP-sensitive potassium (KATP) channel genes KCNJ11 and ABCC8. Additionally, alteration in chromosome 6q24 imprinting, such as overexpression of genes on the 6q24 region of the chromosome, is also a causative factor.
What Are the Signs and Symptoms of Transient Diabetes Mellitus of the Newborn?
A newborn having transient diabetes mellitus will exhibit the following symptoms:
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The baby may be born prematurely.
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The infant will be born with a low birth weight.
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The insulin level will be decreased.
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The body of the newborn will look dehydrated.
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The newborn will have a large tongue called macroglossia.
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The infant will have a hiatal hernia. Hiatal hernia is a condition in which the upper part of the stomach protrudes through a hole in the diaphragm.
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The newborn child might have a structural defect in the heart.
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The infant may be born with a defect in their kidney, limbs, nervous system (which affects the brain development), or urinary system.
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The newborn baby might have problems with hearing.
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The infant might have decreased muscular tone called hypotonia.
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Hypothyroidism is also common in these babies.
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Delayed development is also a feature of this disorder.
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Seizures might occur in these newborns.
How Is Transient Diabetes Mellitus of the Newborn Diagnosed?
The diagnosis of transient diabetes Mellitus is made based on a genetic test, laboratory findings, and clinical symptoms. The various diagnostic tools for this rare disorder have been discussed below.
1. Genetic Testing: Genetic testing is the confirmatory test for transient diabetes mellitus in newborns. If this test shows a chromosome 6q24 imprinting abnormality or mutation in the ABCC8 or KCNJ11 gene, a diagnosis of transient diabetes mellitus can be confirmed. This test is important as it reveals the affected gene; accordingly, the treatment plan can be planned.
2. Laboratory Findings: If the blood glucose level is repeatedly exceeding 250 mg/dL without apparent cause in the newborn, diabetes mellitus of the newborn or neonatal diabetes may be suspected. These kinds of cases are supervised by a neonatologist. When hyperglycemia (increased level of blood sugar) lasts for more than seven to ten days, neonatologists suspect diabetes. Apart from a blood sugar test, the urine test is also done for urine ketones. C-peptide and insulin tests are also carried out to check for diabetes.
Once neonatal diabetes has been diagnosed, it must be determined if it is transient or permanent. To rule out which type of neonatal diabetes, the blood sugar test is repeated after a few weeks. If the hyperglycemia only lasts a few days to weeks and disappears on its own, it is considered transient. If it does not resolve after a few weeks and persists, it is considered permanent neonatal diabetes mellitus. However, even if the hyperglycemia goes away, genetic testing should be done straight away because transient diabetes Mellitus in a newborn can reappear in puberty.
3. Clinical Findings: Although there is no specific clinical feature for transient diabetes mellitus in newborns, if the baby is born prematurely or has a low birth weight with a large tongue and deafness, this disorder can be suspected. However, confirmation can be done only after a blood sugar report and genetic testing.
4. Scans: Sometimes, an ultrasound of the pancreas is done to check for the presence of the pancreas. Any abnormality in the pancreas or defect can also lead to diabetes. So, if a pancreatic-related abnormality is the cause of diabetes, treatment will be planned accordingly.
How Is Transient Diabetes Mellitus of the Newborn Treated?
The treatment starts with the administration of intravenous insulin and rehydration of the newborn. Once the appropriate glucose level is achieved, the subcutaneous insulin pump can be given for insulin administration. In addition, insulin glargine injections can also be used to control the blood sugar level. Parents are properly educated on how to use an insulin pump for their newborn after discharge from the hospital. In some patients, oral sulfonylurea medication can also be used.
How Is Transient Diabetes Mellitus of New Born Different From Juvenile Diabetes?
Transient diabetes mellitus of newborns and juvenile diabetes both appear in childhood. However, both are entirely different from each other. Transient diabetes in the newborn is a genetic disorder that occurs due to mutation in some genes, whereas juvenile or type 1 diabetes is an autoimmune disorder where insulin is not produced by the pancreas. The former occurs in newborns, and the latter appears in children ages four to six or early puberty.
Conclusion:
Transient diabetes mellitus of the newborn occurs within the initial days or weeks (usually within six months) after birth. It usually resolves within the first year of life; however, its remission is possible. In studies, it has been found that the majority of the newborns who develop transient diabetes mellitus soon after birth, when treated properly with insulin, showed a normal blood sugar level and optimal general health later in life without any complications.
