SUN-LB027 Successful Transition from Insulin Injections to Oral Sufonylurea Therapy in Children with Non Autoimmune Type 1 Diabetes (T1D)

Background: Children with non autoimmune T1D may have unrecognized monogenic forms of diabetes with the potential to respond to oral sulfonylurea therapy and avoid the burden of insulin injections. However, the genetic testing for monogenic diabetes is costly and may not be readily accessible to all families. We report on three patients with non autoimmune T1D on insulin therapy, with specific clinical features suggestive of monogenic forms of diabetes, who underwent successful transition to oral Glyburide (GB) therapy and maintained stable glycemic control off insulin therapy. Clinical Case: Three children, aged 9-14 years, who were non obese, non ketotic, islet cell antibody and GAD 65 antibody negative, who have been on insulin injection therapy at 0.5-1 u /kg/day for 2-4 years, were started with oral Glyburide (GB) therapy at 2.5-5 mg daily with concomitant slow weaning of insulin therapy. Over 2-3 weeks, insulin therapy was completely weaned off while maintaining GB therapy. All patients were monitored closely for blood glucose levels along with c-peptide and Hgba1c levels. All 3 cases showed improved blood glucose levels from upper 100s to 200s mg/dl on insulin therapy to 74-144 mg/dl on GB therapy. Hgba1c levels improved from 9-10.3 % while on insulin therapy to 5.8-7.2 % on GB therapy. No significant hypoglycemia or hyperglycemia was noted during the transition with close follow up and labs demonstrated normalization of c-peptide levels on GB therapy. Glycemic control remains stable on GB therapy while off insulin therapy during follow up for 2-3 years. Blood glucose monitoring has been decreased from 4-6 times daily on insulin therapy to 2-3 times daily on GB therapy. Conclusion: Children with non autoimmune T1D, with features suggestive of monogenetic forms of diabetes, can be successfully transitioned to oral GB therapy from insulin therapy. This highlights the need to indentify this patient population and to make genetic testing more readily accessible for patients who may be candidates for oral therapy. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.