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Physiological and clinical role of insulin in the neonate
Kathryn Beardsall1, Carlo Acerini2, David B Dunger3
1a Department of Paediatrics, University of Cambridge, Box 116, Level 8, Addenbrooke's University Hospital NHS Trust, Hills Road, Cambridge CB2 0QQ, UK. kb274@cam.ac.uk.
Insights
Neonatal insulin secretion adapts to postnatal feeding. Understanding neonatal diabetes and insulin management in preterm infants is crucial for growth and glucose homeostasis.
Area of Science:
- Endocrinology
- Neonatology
- Metabolic Disorders
Background:
- Neonatal infants must adapt insulin secretion from continuous placental glucose to intermittent oral feeds.
- Insulin's roles in glucose homeostasis, growth, and anabolism are critical in newborns.
- Neonatal diabetes and insulin resistance in preterm infants present challenges in hyperglycemia and growth.
Purpose of the Study:
- To review the complexities of insulin secretion and glucose regulation in newborn infants.
- To discuss the genetic basis and treatment of neonatal diabetes.
- To examine glucose control and insulin therapy in preterm and very-low-birthweight infants.
Main Methods:
- Review of current literature on neonatal glucose metabolism and insulin secretion.
- Analysis of genetic factors contributing to neonatal diabetes.
- Discussion of clinical management strategies, including insulin pump therapy.
Main Results:
- Genetic discoveries have illuminated beta-cell function mechanisms in neonatal diabetes.
- Insulin pump therapy has improved management for some infants with neonatal diabetes.
- Optimal insulin management for preterm infants with hyperglycemia and insulin resistance remains controversial.
Conclusions:
- Effective management of insulin secretion is vital for neonatal glucose homeostasis and growth.
- While neonatal diabetes treatments are advancing, many infants require ongoing insulin therapy.
- Further research is needed to establish optimal glucose control strategies for high-risk preterm infants.
Abstract:
In the newborn infant, insulin secretion has to adjust in response to the switch from a regulated and continuous placental supply of glucose in utero to the delivery of intermittent oral feeds postnatally. Changes in insulin secretion must reflect its primary role for maintaining glucose homeostasis, but also its roles in promoting growth and anabolism and in the newborn disorders of insulin secretion or sensitivity, which present with hyperglycemia and impaired growth. Recent elucidation of the genetic basis of neonatal diabetes has helped to provide valuable insights into the molecular mechanisms of β-cell function and the potential for treatment of some patients with oral hypoglycemic agents, although the majority require prolonged subcutaneous insulin treatment, which may prove challenging. The recent development of insulin pump therapy has significantly improved the clinical management of these infants. Although they do not have neonatal diabetes, the preterm or very-low-birthweight infant, subjected to the combined effects of insulin resistance owing to the impact of intensive care, and relative insulin deficiency related to prematurity, may have long periods of hyperglycemia and impaired growth, which have been associated with adverse clinical outcomes. Although these infants often require insulin treatment, the optimal management of glucose control and use of insulin has not been determined and remains controversial.
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