Garin et al. 2010 studied a Lebanese family with 2 male cousins affected by permanent neonatal diabetes. Both cousins were born of consanguineous unions and carried a large homozygous deletion that removes a segment of the promoter, exon 1 and exon 2 of INS (c.-370-?_186+?del). 6 other extended family members had adult-onset diabetes.  

Bappal et al. (1999) estimated the prevalence and incidence rates of permanent neonatal insulin dependant diabetes mellitus (PNIDDM) and described its profile in Oman by studying all children (five children) diagnosed with this condition between 1991 and 1995. They were also investigated by viral serology for TORCH and Coxackie virus, presence of islet cells antibodies by indirect immunofluorescence technique on human pancreatic sections, plasma C-peptide concentration by radioimmunoassay, and glycated hemoglobin. HLA typing of all the children was also undertaken. The treatment plan was the same in all the children with a combination of intermediate and short acting human insulin once or twice a day according to the patient's needs. The prevalence and incidence rates (which included the prevalence of insulin dependant diabetes mellitus among the children of under five years) were estimated by using the final results of the general census of population which was published yearly by the Ministry of Health. The mean incidence of PNIDDM during the study period was found to be 2.2/100,000 live births/year which was the highest reported in the world, and the prevalence of IDDM in children under five years by the end of 1995 was 2.0 per 100,000 with 8.8% of all the cases of IDDM in this age group being those with PNIDDM. All children in this study had consanguineous parents, and the prevalences of IDDM and NIDDM were high among their siblings, parents and relatives. Two siblings' father and paternal aunt had IDDM, and NIDDM was found in their grandfather and granduncle, while one mother had gestational diabetes, Hashimoto's thyroiditis was found in another mother and a third mother had vitiligo. The mean age of onset was 15.4 days (6 to 20 days), the mean duration of symptoms before diagnosis was 4.4 days (2 to 8 days), and the presenting symptoms were diarrhea and dehydration in all children, while four out of the five children had fever, polyuria, tachypnea, or lethargy and poor feeding. All children were born with intrauterine growth retardation as their mean birth weights was 1.86 kg (1.5 kg to 2.3 kg), and they were of low weight at the time of diagnosis (mean of 1.94 kg). Initial investigations revealed mean blood glucose of 34.4mmol which did not correlate with either the age of onset or the duration of symptoms, and mean pH of 7.17 (80% had pH less than 7.2) which correlated significantly with the blood glucose. They also had significantly high triglycerides with a mean of 19.06, and mild to moderate ketonuria in four children. Other investigations revealed hyponatremia (sodium did not correlate with blood glucose level), hyperkalemia (potassium did not correlate with blood pH), prerenal uremia in 80% of the children (urea did not correlate with creatinine), and negative viral serology (IgG and IgM classes). No islet cells antibodies were detected in any of the children. During the course of the illness, three infants were admitted five times in the first year for symptomatic hypoglycemia, and three other patients had three episodes of ketoacidosis. There was no evidence of partial or complete remission in any of the children, and the initial C-peptide on presentation was less than 0.199 pmol/l during hyperglycemia and the level continued to be low in serial measurements, reflecting absence of endogenous insulin secretion. HLA typing of the patients revealed HLA DR3 and/or DR4 in 80% of the children which were common HLA loci associated with IDDM. One child developed autoimmune hypothyroidism with the presence of thyroid antibodies and biochemical hypothyroidism, while another child died at the age of 2.5 years after aggressive hepatitis and liver failure following transfusion.

Soliman et al. (1999) corrected the incidence rate of PNIDDM in the Sultanate of Oman during the study period from January 1989 to December 1994 to be 1.788 +/- 0.82 per 100,000 live births per year. They added that at the end of December 1994 the prevalence rate was 2.4 per 100,000 children below the age of 5 years. They constituted 41.6% of all cases of IDDM in this age group. Diarrhea, fever, lethargy, poor feeding and failure to thrive were the most common presenting symptoms. Despite marked growth retardation at birth, there was a significant improvement of growth after initiating insulin therapy. Four of the five patients had normal developmental milestones, one had mild developmental delay following a severe and prolonged attack of hypoglycemia. None of the patients had exocrine pancreatic deficiency.

Deeb et al. (2016) found 25 cases of Neonatal Diabetes Mellitus in Abu Dhabi between the years 1985-2013, giving an incidence rate of 1:29,241 live births. Of these, 23 patients had Permanent Neonatal Diabetes Mellitus (PNDM, incidence rate 1:31,900). The authors noted that the incidence of PNDM was among the highest in the world. Genetic analysis identified causal variants in EIF2AK3, INS and KCNJ11 (see table above). The causal variant could not be identified in an additional 4 unrelated Emirati patients with PNDM. Of these, 2 patients had isolated PNDM, one had PNDM with Down syndrome wile another had PNDM with an absent pancreas.