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• Low dose Diazoxide for Hyper-insulinemic hypoglycemia- Do we agree?
  Supreet Khurana
  Published on: 17 June 2022

• Published on: 17 June 2022

  Low dose Diazoxide for Hyper-insulinemic hypoglycemia- Do we agree?

  • Supreet Khurana, Assistant Professor, Neonatology Government Medical College and Hospital, Chandigarh

  We read with great interest this article published by Chandran et al. However, we have some critical
  reservations on implementation of low dose diazoxide. The target blood glucose thresholds used for
  management have been taken from Pediatric endocrine society guidelines of 2015, which are based
  on adult neuroglycopenic effects. However, AAP guidelines recommend a lower treatment target of
  <2.2 mmol/l (40 mg/dl) for asymptomatic,<2.5 mmol/l (45 mg/dl) for symptomatic neonates
  during first 48 hours and <3.3 mmol/l (60mg/dl) thereafter (1, 2) . Moreover, in a recent multi-centric
  trial published by Kempen et al; it was concluded that low treatment threshold of <2 mmol/l (36
  mg/dl) was non inferior in terms of neurodevelopmental outcomes at 18 months of age in healthy
  asymptomatic neonates (3) . Hence it is still debatable whether all the neonates being managed for
  hypoglycemia warranted an intravenous glucose infusion therapy and diazoxide.
  Authors have used a combination of starting dose of diazoxide along with hydrochlorothiazide for
  management of SGA neonates; which are known to have a synergistic effect on increasing blood
  glucose levels, hence actual dose of diazoxide required if used alone could have been potentially
  higher in these neonates.
  In the study design the authors have mentioned that this was an observational cohort study,
  however neither the absence of compar...

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  We read with great interest this article published by Chandran et al. However, we have some critical
  reservations on implementation of low dose diazoxide. The target blood glucose thresholds used for
  management have been taken from Pediatric endocrine society guidelines of 2015, which are based
  on adult neuroglycopenic effects. However, AAP guidelines recommend a lower treatment target of
  <2.2 mmol/l (40 mg/dl) for asymptomatic,<2.5 mmol/l (45 mg/dl) for symptomatic neonates
  during first 48 hours and <3.3 mmol/l (60mg/dl) thereafter (1, 2) . Moreover, in a recent multi-centric
  trial published by Kempen et al; it was concluded that low treatment threshold of <2 mmol/l (36
  mg/dl) was non inferior in terms of neurodevelopmental outcomes at 18 months of age in healthy
  asymptomatic neonates (3) . Hence it is still debatable whether all the neonates being managed for
  hypoglycemia warranted an intravenous glucose infusion therapy and diazoxide.
  Authors have used a combination of starting dose of diazoxide along with hydrochlorothiazide for
  management of SGA neonates; which are known to have a synergistic effect on increasing blood
  glucose levels, hence actual dose of diazoxide required if used alone could have been potentially
  higher in these neonates.
  In the study design the authors have mentioned that this was an observational cohort study,
  however neither the absence of comparison group nor the retrospective nature of study been
  clearly disclosed in the methodology (4) .

  Finally, to make the study findings more generalizable; it shall be of greater interest to know the
  long-term neurodevelopmental outcomes in this group of neonates.

  References
  1. Committee on F, Newborn, Adamkin DH. Postnatal glucose homeostasis in late-preterm and
  term infants. Pediatrics. 2011;127(3):575-9.
  2. Thornton PS, Stanley CA, De Leon DD, Harris D, Haymond MW, Hussain K, et al.
  Recommendations from the Pediatric Endocrine Society for Evaluation and Management of
  Persistent Hypoglycemia in Neonates, Infants, and Children. The Journal of pediatrics.
  2015;167(2):238-45.
  3. van Kempen A, Eskes PF, Nuytemans D, van der Lee JH, Dijksman LM, van Veenendaal NR, et
  al. Lower versus Traditional Treatment Threshold for Neonatal Hypoglycemia. N Engl J Med.
  2020;382(6):534-44.
  4. Chandran S, R PR, Mei Chien C, Saffari SE, Rajadurai VS, Yap F. Safety and efficacy of low-
  dose diazoxide in small-for-gestational-age infants with hyperinsulinaemic hypoglycemia.
  2021:fetalneonatal-2021-322845.

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  Conflict of Interest:
  None declared.

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