Improvement in glycaemic parameters using SGLT-2 inhibitor and GLP-1 agonist in combination in an adolescent with diabetes mellitus and Prader-Willi syndrome: a case report
Autor: | Christine P Burren, Kruthika Narayan, Chris Moudiotis, Toby Candler, David McGregor |
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Rok vydání: | 2020 |
Předmět: |
Blood Glucose
medicine.medical_specialty Adolescent Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism Type 2 diabetes 03 medical and health sciences 0302 clinical medicine Endocrinology Insulin resistance Glucosides Glucagon-Like Peptide 1 Internal medicine Diabetes mellitus Diabetes Mellitus medicine Humans 030212 general & internal medicine Benzhydryl Compounds Child Sodium-Glucose Transporter 2 Inhibitors Type 1 diabetes Liraglutide business.industry Insulin nutritional and metabolic diseases medicine.disease Metformin Treatment Outcome Pediatrics Perinatology and Child Health Drug Therapy Combination Female medicine.symptom business Prader-Willi Syndrome Polydipsia medicine.drug |
Zdroj: | Journal of Pediatric Endocrinology and Metabolism. 33:951-955 |
ISSN: | 2191-0251 0334-018X |
Popis: | Objectives Prader-Willi Syndrome (PWS) is characterised by hyperphagia often leading to obesity; a known risk factor for insulin resistance and type 2 (T2) diabetes. We present a prepubertal girl with PWS who developed diabetes. Case presentation Our case was diagnosed with PWS in infancy following investigation for profound central hypotonia and feeding difficulties. She commenced growth hormone (GH) aged 8 years for short stature and treatment improved linear growth. At age 12 years, she presented with polydipsia, polyuria and vulvovaginitis. She was overweight (BMI SDS +1.43). Diabetes was diagnosed (Blood glucose = 24.2 mmol/L, HbA1c = 121 mmol/mol or 13.2%). She was not acidotic and had negative blood ketones. Autoantibodies typical of type 1 diabetes were negative. She was initially treated with basal bolus insulin regime. GH was discontinued 3 months later due to concerns regarding GH-induced insulin resistance. Off GH, insulin requirements reduced to zero, allowing Metformin monotherapy. However off GH, she reported significant lethargy with static growth and increased weight. Combinations of Metformin with differing insulin regimes did not improve glucose levels. Liraglutide (GLP-1 agonist) and Metformin did not improve glucose levels nor her weight. Liraglutide and Empaglifozin (SGLT-2 inhibitor) therapy used in combination were well tolerated and demonstrated rapid normalisation of blood glucose and improvement in her HbA1c to within target (48 mmol/mol) which was sustained after 6 months of treatment. Conclusions Newer treatments for type 2 diabetes (e. g. GLP-1 agonists or SGLT-2 inhibitors) offer potential treatment options for those with diabetes and PWS when conventional treatments are ineffective. |
Databáze: | OpenAIRE |
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