Letters Diabetes

Not every child with diabetes needs insulin

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c6512 (Published 16 November 2010) Cite this as: BMJ 2010;341:c6512
  1. Dario Iafusco, research fellow in paediatrics1,
  2. Andrea E Scaramuzza, head of paediatric diabetology and lecturer in paediatrics2,
  3. Alfonso Galderisi, physician1,
  4. Alessandra Cocca, physician1,
  5. Roberto Giugliano, general practitioner3,
  6. Gian Vincenzo Zuccotti, professor of paediatrics2,
  7. Francesco Prisco, associate professor of paediatrics1
  1. 1Department of Paediatrics, Second University of Naples, 80138 Naples, Italy
  2. 2Department of Paediatrics, University of Milan, “Luigi Sacco” Hospital, 20157 Milan, Italy
  3. 3ASL NA-2 Nord, Naples, Italy
  1. dario.iafusco{at}unina2.it

Insulin is miraculous,1 and, as happens with most good and effective drugs, it has tended to be used whenever doctors meet a child with high blood sugar values. This presupposes that hyperglycaemia in children always means type 1 diabetes, overlooking the existence of many other forms of diabetes that do not require insulin—for example, monogenic diabetes, mitochondrial diabetes, and type 2 diabetes in adolescents.

In the past two decades the pathogenic mechanisms of the most common forms of hyperglycaemia clearly show that not all children have type 1 diabetes.2 Surprisingly, most children with diabetes that is not type 1 are better treated with oral anti-diabetic drugs.3 4 5

We must all therefore try to recognise the non-autoimmune forms of hyperglycaemia in children to avoid insulin treatment when it is not effective. Indeed, it may damage patients and their quality of life, and we cannot afford those risks.

The costs of genetic analysis might be an obstacle in investigating all children with non-autoimmune diabetes; however, it is worth the effort, and the extra costs of screening might be recouped by replacing insulin with cheaper drugs requiring less tight glucose monitoring.

Insulin treatment is undoubtedly cutting edge in medicine and for patients, but how many patients have been treated or are being treated with insulin unnecessarily?


Cite this as: BMJ 2010;341:c6512


  • Competing interests: None declared.


View Abstract