Your activity: 8 p.v.

Monogenic diabetes*: More commonly identified gene mutations

Monogenic diabetes*: More commonly identified gene mutations
Type Genetic defect Frequency Beta cell defect Clinical features Risk of microvascular disease Optimal treatment
1 Hepatocyte nuclear factor-4-alpha <10% Reduced insulin secretory response to glucose Normal renal threshold for glucose Yes Sulfonylureas
2 Glucokinase 15 to 31% Defective glucokinase molecule (glucose sensor), increased plasma levels of glucose are necessary to elicit normal levels of insulin secretion Mild, stable, fasting hyperglycemia, often diagnosed during routine screening. Not progressive. Generally no Diet
3 Hepatocyte nuclear factor-1-alpha 52 to 65% Abnormal insulin secretion, low renal threshold for glucose Low renal threshold for glucose, +glycosuria Yes Sulfonylureas
4 Insulin promoter factor 1 Rare Reduced binding to the insulin gene promoter, reduced activation of insulin gene in response to hyperglycemia Rare, pancreatic agenesis in homozygotes, less severe mutations result in mild diabetes Yes  
5 Hepatocyte nuclear factor-1-beta Rare   Pancreatic atrophy, renal dysplasia, renal cysts, renal insufficiency, hypomagnesemia Yes Insulin
6 Neurogenic differentiation factor-1 Rare Pancreatic development   Yes Insulin
* Formerly called maturity onset diabetes of the young (MODY).
Data from:
  1. Naylor R, Philipson LH. Who should have genetic testing for maturity-onset diabetes of the young? Clin Endocrinol (Oxf) 2011; 75:422.
  2. Ramesh SC, Marshall I. Clinical suspicion of Maturity Onset of Diabetes of the Young in pediatric patients diagnosed with diabetes mellitus. Indian J Pediatr 2012; 79:955.
  3. Thanabalasingham G, Owen KR. Diagnosis and management of maturity onset diabetes of the young (MODY). BMJ 2011; 343:d6044.
Graphic 83071 Version 6.0