Sulfonylureas, If Used Quickly, Appear to Reverse Neonatal Diabetes

A report in the February 4, 2009, issue of Cell Metabolism says that babies born with neonatal diabetes might be able to avoid irreversible damage to the pancreas if doctors treat them quickly with sulfonylureas rather than insulin.

In neonatal diabetes, an inherited condition, there is a defect in the pancreas’s potassium channels, which fail to close as they should in response to glucose. The resultant spike in blood sugar damages the pancreas’s insulin-producing beta cells, often leading to permanent damage. 

Researchers at the Washington University School of Medicine in St. Louis and the University of Cologne in Germany found that in laboratory mice bred to have “overactive” potassium channels, the injection of sulfonylureas blocked the opened channels, allowing the pancreas to return to a healthy state.

Usually infants born with neonatal diabetes are treated with insulin, which addresses the problem of insulin deficiency, but does not treat its underlying cause. The results of the study suggest that doctors could soon have a treatment tool that reverses rather than merely mitigates neonatal diabetes.  

Sulfonylureas are familiar to most type 2 patients with diabetes because they are typically the second drugs that doctors prescribe, in a sequence that leads from metformin through the sulfonylureas to such drugs as the TZD pioglitazone (Actos), the DPP-4 inhibitor sitagliptin phosphate (Januvia), or the GLP-1 incretin exenatide (Byetta).   

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