Vnitr Lek 2018, 64(4):367-374 | DOI: 10.36290/vnl.2018.054

Diagnosis of MODY - brief overview for clinical practice

Jana Urbanová1,*, Ludmila Brunerová1, Jan Brož2
1 Diabetologické centrum II. interní kliniky 3. LF UK a FN Královské Vinohrady, Praha
2 Interní klinika 2. LF UK a FN Motol, Praha

Maturity Onset Diabetes of the Young (MODY) comprises inherited forms of diabetes mellitus caused by the mutations in the genes involved in the development, differentiation and function of beta-cells. The majority of patients with MODY remains misdiagnosed and erroneously classified as type 1 or type 2 diabetic patients. Correct MODY diagnosis is, however, essential since it enables individualization of treatment, assessment of the prognosis and identification of diabetes among patient's relatives. Clinical presentation of MODY is highly variable and it could resemble other types of diabetes, thus identification of MODY patients might be difficult. In this review, we describe typical clinical presentation of the most common MODY subtypes, we summarize current diagnostic guidelines in confirmation of MODY and we raise the question of possible need for extension of current clinical criteria indicating a patient for molecular-genetic testing.

Keywords: clinical course; diagnosis; differential diagnosis; glucokinase; hepatocyte nuclear factors; MODY

Received: November 27, 2017; Accepted: January 14, 2018; Published: April 1, 2018  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Urbanová J, Brunerová L, Brož J. Diagnosis of MODY - brief overview for clinical practice. Vnitr Lek. 2018;64(4):367-374. doi: 10.36290/vnl.2018.054.
Download citation

References

  1. Tattersall RB. Mild familial diabetes with dominant inheritance. QJ Med 1974; 43(170): 339-357.
  2. Průhová Š, Ek J, Lébl J et al. Genetic epidemiology of MODY in the Czech Republic: Novel mutations in the MODY genes HNF-4α, GCK and HNF-1α. Diabetologia 2003; 46(2): 291-295. Go to original source... Go to PubMed...
  3. Shepherd M, Ellis I, Ahmad AM et al. Predictive genetic testing in maturity-onset diabetes of the young (MODY). Diabet Med 2001; 18(5): 417-421. Go to original source... Go to PubMed...
  4. Shepherd M, Miles S, Jones J et al. Differential diagnosis: Identifying people with monogenic diabetes. J Diabetes Nurs 2010; 14(9): 342-347.
  5. Byrne MM, Sturis J, Clement K et al. Insulin secretory abnormalities in subjects with hyperglycemia due to glucokinase mutations. J Clin Invest 1994; 93(3): 1120-1130. Dostupné z DOI: <http://dx.doi.org/10.1172/JCI117064>. Go to original source... Go to PubMed...
  6. Ellard S, Bellanné-Chantelot C, Hattersley AT. [European Molecular Genetics Quality Network (EMQN) MODY group]. Best practice guidelines for the molecular genetic diagnosis of maturity-onset diabetes of the young. Diabetologia 2008; 51(4): 546-553. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-008-0942-y>. Go to original source... Go to PubMed...
  7. Stride A, Vaxillaire M, Tuomi T et al. The genetic abnormality in the beta cell determines the response to an oral glucose load. Diabetologia 2002; 45(3): 427-435. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-001-0770-9>. Go to original source... Go to PubMed...
  8. Steele AM, Wensley KJ, Ellard S et al. Use of HbA1c in the identification of patients with hyperglycaemia caused by a glucokinase mutation: observational case control studies. PloS One 2013; 8(6): e65326. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0065326>. Go to original source... Go to PubMed...
  9. Stride A, Shields B, Gill-Carey O et al. Cross-sectional and longitudinal studies suggest pharmacological treatment used in patients with glucokinase mutations does not alter glycaemia. Diabetologia 2014; 57(1): 54-56. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-013-3075-x>. Go to original source... Go to PubMed...
  10. Spyer G, Hattersley AT, Sykes JE et al. Influence of maternal and fetal glucokinase mutations in gestational diabetes. Am J Obstet Gynecol 2001; 185(1): 240-241. Dostupné z DOI: <http://dx.doi.org/10.1067/mob.2001.113127>. Go to original source... Go to PubMed...
  11. Bacon S, Kyithar MP, Schmid J et al. Serum levels of pancreatic stone protein (PSP)/reg1A as an indicator of beta-cell apoptosis suggest an increased apoptosis rate in hepatocyte nuclear factor 1 alpha (HNF1A-MODY) carriers from the third decade of life onward. BMC Endocr Disord 2012; 12: 13. Dostupné z DOI: <http://dx.doi.org/10.1186/1472-6823-12-13>. Go to original source... Go to PubMed...
  12. Yamagata K. Roles of HNF1α and HNF4α in pancreatic β-cells: lessons from a monogenic form of diabetes (MODY). Vitam Horm 2014; 95: 407-423. Dostupné z DOI: <http://dx.doi.org/10.1016/B978-0-12-800174-5.00016-8>. Go to original source... Go to PubMed...
  13. Stride A, Hattersley AT. Different genes, different diabetes: lessons from maturity-onset diabetes of the young. Ann Med 2002; 34(3): 207-216. Go to original source...
  14. Pontoglio M, Prié D, Cheret C et al. HNF1alpha controls renal glucose reabsorption in mouse and man. EMBO Rep 2000; 1(4): 359-365. Dostupné z DOI: <http://dx.doi.org/10.1093/embo-reports/kvd071>. Go to original source... Go to PubMed...
  15. Pearson ER, Pruhova S, Tack CJ et al. Molecular genetics and phenotypic characteristics of MODY caused by hepatocyte nuclear factor 4alpha mutations in a large European collection. Diabetologia 2005; 48(5): 878-885. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-005-1738-y>. Go to original source... Go to PubMed...
  16. Murphy R. Monogenic diabetes and pregnancy. Obstet Med 2015; 8(3): 114-120. Dostupné z DOI: <http://dx.doi.org/10.1177/1753495X15590713>. Go to original source... Go to PubMed...
  17. Stride A, Shepherd M, Frayling TM et al. Intrauterine hyperglycemia is associated with an earlier diagnosis of diabetes in HNF-1α gene mutation carriers. Diabetes Care 2002; 25(12): 2287-2291. Go to original source... Go to PubMed...
  18. Stride A, Ellard S, Clark P et al. Beta-cell dysfunction, insulin sensitivity, and glycosuria precede diabetes in hepatocyte nuclear factor-1alpha mutation carriers. Diabetes Care 2005; 28(7): 1751-1756. Go to original source... Go to PubMed...
  19. McDonald TJ, McEneny J, Pearson ER et al. Lipoprotein composition in HNF1A-MODY: Differentiating between HNF1A-MODY and Type 2 diabetes. Clin Chim Acta 2012; 413(9-10): 927-932. Go to original source... Go to PubMed...
  20. Thanabalasingham G, Pal A, Selwood MP et al. Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of Young-Onset Type 2 Diabetes Is a Successful Strategy for Identifying Maturity-Onset Diabetes of the Young. Diabetes Care 2012; 35(6): 1206-1212. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11-1243>. Go to original source... Go to PubMed...
  21. Isomaa B, Henricsson M, Lehto M et al. Chronic diabetic complications in patients with MODY3 diabetes. Diabetologia 1998; 41(4): 467-473. Dostupné z DOI: <http://dx.doi.org/10.1007/s001250050931>. Go to original source... Go to PubMed...
  22. Steele AM, Shields BM, Shepherd M et al. Increased all-cause and cardiovascular mortality in monogenic diabetes as a result of mutations in the HNF1A gene. Diabet Med 2010; 27(2): 157-161. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464-5491.2009.02913.x>. Go to original source... Go to PubMed...
  23. Coffinier C, Thepot D, Babinet C et al. Essential role for the homeoprotein vHNF1/HNF1beta in visceral endoderm differentiation. Development 1999; 126(21): 4785-4794. Go to original source... Go to PubMed...
  24. Ulinski T, Lescure S, Beaufils S et al. Renal phenotypes related to hepatocyte nuclear factor-1beta (TCF2) mutations in a pediatric cohort. J Am Soc Nephrol 2006; 17(2): 497-503. Dostupné z DOI: <http://dx.doi.org/10.1681/ASN.2005101040>. Go to original source... Go to PubMed...
  25. Edghill EL, Bingham C, Ellard S et al. Mutations in hepatocyte nuclear factor-1beta and their related phenotypes. J Med Genet 2005; 43(1): 84-90. Dostupné z DOI: <http://dx.doi.org/10.1136/jmg.2005.032854>. Go to original source... Go to PubMed...
  26. Pearson ER, Badman MK, Lockwood CR et al. Contrasting diabetes phenotypes associated with hepatocyte nuclear factor-1alpha and -1beta mutations. Diabetes Care 2004; 27(5): 1102-1107. Go to original source... Go to PubMed...
  27. Edghill EL, Bingham C, Slingerland AS et al. Hepatocyte nuclear factor-1 beta mutations cause neonatal diabetes and intrauterine growth retardation: support for a critical role of HNF-1beta in human pancreatic development. Diabet Med 2006; 23(12): 1301-1306. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464-5491.2006.01999.x>. Go to original source... Go to PubMed...
  28. Gardner DS, Tai ES. Clinical features and treatment of maturity onset diabetes of the young (MODY). Diabetes Metab Syndr Obes 2012; 5: 101-108. Dostupné z DOI: <http://dx.doi.org/10.2147/DMSO.S23353>. Go to original source... Go to PubMed...
  29. MODY Probability Calculator. Dostupné z WWW: <http://www.diabetesgenes.org/content/mody-probability-calculator>.
  30. Shields BM, McDonald TJ, Ellard S et al. The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes. Diabetologia 2012; 55(5): 1265-1272. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-011-2418-8>. Go to original source... Go to PubMed...
  31. Hattersley AT, Beards F, Ballantyne E et al. Mutations in the glucokinase gene of the fetus result in reduced birth weight. Nat Genet 1998; 19(3): 268-270. Dostupné z DOI: <http://dx.doi.org/10.1038/953>. Go to original source... Go to PubMed...
  32. Ellard S, Beards F, Allen LIS et al. A high prevalence of glucokinase mutations in gestational diabetic subjects selected by clinical criteria. Diabetologia 2000; 43(2): 250-253. Dostupné z DOI: <http://dx.doi.org/10.1007/s001250050038>. Go to original source... Go to PubMed...
  33. Chakera AJ, Spyer G, Vincent N et al. The 0.1% of the Population With Glucokinase Monogenic Diabetes Can Be Recognized by Clinical Characteristics in Pregnancy: The Atlantic Diabetes in Pregnancy Cohort. Diabetes Care May 2014; 37(5): 1230-1236. Dostupné z DOI: <http://dx.doi.org/10.2337/dc13-2248>. Go to original source... Go to PubMed...
  34. Murphy R, Ellard S, Hattersley AT. Clinical implications of a molecular genetic classification of monogenic β-cell diabetes. Nat Clin Pract Endocrinol Metab 2008; 4(4): 200-213. Dostupné z DOI: <http://dx.doi.org/10.1038/ncpendmet0778>. Go to original source... Go to PubMed...
  35. Owen KR, Shepherd M, Stride A et al. Heterogeneity in young adult onset aetiology alters clinical characteristics. Diabet Med 2002; 19(9): 758-761. Go to original source... Go to PubMed...
  36. McDonald TJ, Shields BM, Lawry J et al. High-sensitivity CRP discriminates HNF1A-MODY from other subtypes of diabetes. Diabetes Care 2011; 34: 1860-1862. Dostupné z DOI: <http://dx.doi.org/10.2337/dc11-0323>. Go to original source... Go to PubMed...
  37. Besser REJ, Shepherd MJ, McDonald TJ et al. Urinary C-peptide creatinine ratio (UCPCR) is a practical outpatient tool for identifying HNF1A/HNF4A MODY from long duration Type 1 diabetes. Diabetes Care 2011; 34(2): 286-291. Dostupné z DOI: <http://dx.doi.org/10.2337/dc10-1293>. Go to original source... Go to PubMed...
  38. Sagen JV, Pearson ER, Johansen A et al. Preserved insulin response to tolbutamide in HNF-1alpha mutation carriers. Diabet Med 2005; 22(4): 406-409. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464-5491.2005.01439.x>. Go to original source... Go to PubMed...
  39. Pearson ER, Boj SF, Steele AM et al. Macrosomia and hyperinsulinaemic hypoglycaemia in patients with heterozygous mutations in the HNF4A gene. PLoS Med 2007; 4(4): e118. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pmed.0040118>. Go to original source... Go to PubMed...
  40. Grzanka M, Matejko B, Szopa M et al. Assessment of Newly Proposed Clinical Criteria to Identify HNF1A MODY in Patients with an Initial Diagnosis of Type 1 or Type 2 Diabetes Mellitus. Adv Med 2016; 2016: 4243784. Dostupné z DOI: <http://dx.doi.org/10.1155/2016/4243784>. Go to original source... Go to PubMed...
  41. Petruzelkova L, Dusatkova P, Cinek O et al. Substantial proportion of MODY among multiplex families participating in a Type 1 diabetes prediction programme. Diabet Med 2016; 33(12): 1712-1716. Dostupné z DOI: <http://dx.doi.org/10.1111/dme.13043>. Go to original source... Go to PubMed...
  42. Bellanne-Chantelot C, Chauveau D, Gautier JF et al. Clinical spectrum associated with hepatocyte nuclear factor-1beta mutations. Ann Intern Med 2004; 140(7): 510-517. Go to original source... Go to PubMed...
  43. Chen YZ, Gao Q, Zhao XZ et al. Systematic review of TCF2 anomalies in renal cysts and diabetes syndrome/maturity onset diabetes of the young type 5. Chin Med J (Engl) 2010; 123(22): 3326-3333. Go to PubMed...
  44. Adalat S, Woolf AS, Johnstone KA et al. HNF1B mutations associate with hypomagnesemia and renal magnesium wasting. J Am Soc Nephrol 2009; 20(5): 1123-1131. Dostupné z DOI: <http://dx.doi.org/10.1681/ASN.2008060633>. Go to original source... Go to PubMed...
  45. Bellanné-Chantelot C, Carette C, Riveline JP et al. The type and the position of HNF1A mutation modulate age at diagnosis of diabetes in patients with maturity-onset diabetes of the young (MODY)-3. Diabetes 2008; 57(2): 503-508. Dostupné z DOI: <http://dx.doi.org/10.2337/db07-0859>. Go to original source... Go to PubMed...
  46. Lango Allen H, Johansson S, Ellard S et al. Polygenic risk variants for type 2 diabetes susceptibility modify age at diagnosis in monogenic HNF1A diabetes. Diabetes 2010; 59(1): 266-271. Dostupné z DOI: <http://dx.doi.org/10.2337/db09-0555>. Go to original source... Go to PubMed...
  47. Klupa T, Warram JH, Antonellis A et al. Determinants of the development of diabetes (maturity-onset diabetes of the young-3) in carriers of HNF-1α mutations: evidence for parent-of-origin effect. Diabetes Care 2002; 25(12): 2292-2301. Go to original source... Go to PubMed...
  48. Frayling TM, Evans JC, Bulman MP et al. Beta-cell genes and diabetes: molecular and clinical characterization of mutations in transcription factors. Diabetes 2001; 50(Suppl 1): S94-S100. Go to original source... Go to PubMed...
  49. Shepherd M, Hattersley AT, Sparkes A. Genetic testing in maturity onset diabetes of the young (MODY): a new challenge for the diabetic clinic. Pract Diabetes 2001; 18(1): 16-21. Dostupné z DOI: <https://doi.org/10.1002/pdi.108>. Go to original source...
  50. Knebel B, Mack S, Haas J et al. Divergent phenotypes in siblings with identical novel mutations in the HNF-1α gene leading to maturity onset diabetes of the young type 3. BMC Med Genet 2016; 17(1): 36. Dostupné z DOI: <http://dx.doi.org/10.1186/s12881-016-0297-z>. Go to original source... Go to PubMed...
  51. Urbanová J, Hoffmanová I, Anděl M. Manifestace diabetes mellitus 1. typu u 97leté pacientky. DMEV 2011; 14(1): 22-24. Dostupné z WWW: <http://www.tigis.cz/images/stories/DMEV/2011/01/04_urbanova_dmev_1-11.pdf>.
  52. McDonald TJ, Colclough K, Brown R et al. Islet autoantibodies can discriminate maturity-onset diabetes of the young (MODY) from Type 1 diabetes. Diabet Med 2011; 28(9): 1028-1033. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464-5491.2011.03287.x>. Go to original source... Go to PubMed...
  53. Schober E, Rami B, Grabert M et al. Phenotypical aspects of maturity-onset diabetes of the young (MODY diabetes) in comparison with Type 2 diabetes mellitus (T2DM) in children and adolescents: experience from a large multicenter database. Diabet Med 2009; 26(5): 466-473. Dostupné z DOI: <http://dx.doi.org/10.1111/j.1464-5491.2009.02720.x>. Go to original source... Go to PubMed...
  54. Urbanová J, Rypáčková B, Procházková Z et al. Positivity for islet cell autoantibodies in patients with monogenic diabetes is associated with later diabetes onset and higher HbA1c level. Diabet Med 2014; 31(4): 466-471. Dostupné z DOI: <http://dx.doi.org/10.1111/dme.12314>. Go to original source... Go to PubMed...
  55. Průhová Š, Dušátková P, Neumann D et al. Two cases of diabetic ketoacidosis in HNF1A-MODY linked to severe dehydration: is it time to change the diagnostic criteria for MODY? Diabetes Care 2013; 36(9): 2573-2574. Dostupné z DOI: <http://dx.doi.org/10.2337/dc13-0058>. Go to original source... Go to PubMed...
  56. Stanik J, Dusatkova P, Cinek O et al. De novo mutations of GCK, HNF1A and HNF4A may be more frequent in MODY than previously assumed. Diabetologia 2014; 57(3): 480-484. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-013-3119-2>. Go to original source... Go to PubMed...
  57. Shields BM, Hicks S, Shepherd MH et al. Maturity-onset diabetes of the young (MODY): how many cases are we missing? Diabetologia 2010; 53(12): 2504-2508. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-010-1799-4>. Go to original source... Go to PubMed...
  58. Shields BM, Shepherd M, Hudson M et al. Population-Based Assessment of a Biomarker-Based Screening Pathway to Aid Diagnosis of Monogenic Diabetes in Young-Onset Patients. Diabetes Care 2017; 40(8): 1017-1025. Dostupné z DOI: <http://dx.doi.org/10.2337/dc17-0224>. Go to original source... Go to PubMed...
  59. Hattersley AT, Patel KA. Precision diabetes: learning from monogenic diabetes. Diabetologia 2017; 60(5): 769-777. Dostupné z DOI: <http://dx.doi.org/10.1007/s00125-017-4226-2>. Go to original source... Go to PubMed...
  60. Anik A, Çatli G, Abaci A et al. Maturity-onset diabetes of the young (MODY): an update. J Pediatr Endocrinol Metab 2015; 28(3-4): 251-263. Dostupné z DOI: <http://dx.doi.org/10.1515/jpem-2014-0384>. Go to original source... Go to PubMed...
  61. Škrha J, Pelikánová T, Kvapil M. Doporučený postup péče o diabetes mellitus 2. typu. Česká diabetologická společnost ČLS JEP 2017. Dostupné z WWW: <http://www.diab.cz/dokumenty/standard_lecba_dm_typ_II.pdf>.




Vnitřní lékařství

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.