Testing for monogenic diabetes among children and adolescents with antibody-negative clinically defined Type 1 diabetes

作者：Rubio Cabezas O^*; Edghill E L; Argente J; Hattersley A T

来源：Diabetic Medicine, 2009, 26(10): 1070-1074.

DOI：10.1111/j.1464-5491.2009.02812.x

• idiopathic diabetes
• INS
• insulin gene
• monogenic diabetes
• Type 1b diabetes

Aims
Monogenic diabetes is frequently misdiagnosed as Type 1 diabetes. We aimed to screen for undiagnosed monogenic diabetes in a cohort of children who had a clinical diagnosis of Type 1 diabetes but were pancreatic autoantibody-negative.
Methods
We studied 252 patients diagnosed clinically with Type 1 diabetes between 6 months and 17 years of age. Pancreatic autoantibodies [islet cell autoantibodies (ICA), glutamic acid decarboxylase antibodies (GADA) and/or insulinoma-associated antigen-2 antibodies (IA2A)] were absent in 25 cases (9.9%). The most frequent genes involved in monogenic diabetes [KCNJ11 and INS for neonatal diabetes and HNF1A and HNF4A for maturity-onset diabetes of the young (MODY)] were directly sequenced.
Results
Two of the 25 (8%) antibody-negative patients had de novo heterozygous mutations in INS; c.94G > A (G32S) and c.265C > T (R89C). The two patients presented with non-ketotic hyperglycaemia at 8 and 11 months of age. In contrast, the four antibody-positive patients who presented at a similar age (6-12 months) had a more severe metabolic derangement, manifested as ketosis in all four cases, with ketoacidosis in two. At ages 15 and 5 years, both INS mutation patients were prescribed a replacement dose of insulin with good glycaemic control [glycated haemoglobin (HbA(1c)) 7.0 and 7.2%]. No mutations were found in KCNJ11, HNF1A or HNF4A.
Conclusions
The identification of patients with monogenic diabetes from children with clinically defined Type 1 diabetes may be helped by clinical criteria including the absence of pancreatic autoantibodies.

• 出版日期2009-10