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

dc.contributor.authorMcGregor, David
dc.contributor.authorMoudiotis, Christopher
dc.date.accessioned2020-10-13T08:26:21Z
dc.date.available2020-10-13T08:26:21Z
dc.date.issued2020-07-28
dc.description.abstractObjectives 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.en_US
dc.description.admin-notepublished version (12 month embargo)en_US
dc.identifier.citationCandler T et al. 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. J Pediatr Endocrinol Metab. 2020 Jul 28;33(7):951-955.en_US
dc.identifier.doi10.1515/jpem-2019-0389
dc.identifier.journalJournal of Paediatric Endocrinology and Metabolismen_US
dc.identifier.pmid32447330
dc.identifier.urihttps://hdl.handle.net/11287/621466
dc.language.isoenen_US
dc.publisherSheridan PubFactoryen_US
dc.relation.urlhttps://www.degruyter.com/doi/10.1515/jpem-2019-0389en_US
dc.rights© 2020 Walter de Gruyter GmbH, Berlin/Boston.en_US
dc.subjectPrader-Willi syndromeen_US
dc.subjectSGLT-2 inhibitorsen_US
dc.subjectchildren and adolescentsen_US
dc.subjectincretin therapiesen_US
dc.subjectWessex Classification Subject Headings::Paediatricsen_US
dc.titleImprovement 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 reporten_US
dc.typeCase Reporten_US
dc.type.versionPublisheden_US
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