Table 2.

Pros and Cons of Empiric Sulfonylurea Trial Before Genetic Testing Results Are Available

Pro	Con
May ameliorate neurodevelopmental disability in some cases	Inappropriately high family expectations leading to disappointment (and possibility of increased cost) if attempt fails
Could shorten inpatient stay	Molecular diagnosis may guide treatment based on reported sulfonylurea response in patients with identical mutation
If successful, will reduce overall treatment costs	Risk of hypoglycemia during transition and in those with transient forms of NDM
Much easier to give pills than insulin	Sulfonylurea is not approved by FDA for use in infants (also the case for many forms of insulin)
Safety profile of sulfonylurea use in children remains excellent to date	Unknown long-term risks of sulfonylurea use
Genetic testing approval, results, and/or interpretation could cause delay	Second attempt needed if initial trial fails but genetic testing reveals a KCNJ11 or ABCC8 mutation