Investigating maturity onset diabetes of the young

Abstract

Maturity Onset Diabetes of Young (MODY) is a monogenic and autosomal dominant form of diabetes mellitus with onset of the disease often before 25 years of age. It is due to dysfunction of pancreatic beta cells characterised by non-ketotic diabetes and absence of pancreatic auto-antibodies. It is frequently mistaken for type 1 or type 2 diabetes mellitus. Diagnosis of MODY is important as the GCK subtype has better prognosis and may not require any treatment. Subtypes HNF1A and HNF4A are sensitive to sulfonylureas, however diabetes complications are common if not treated early. Moreover, there is genetic implication for the patient and family. Rare MODY subtypes can be associated with pancreatic and renal anomalies as well as exocrine dysfunction of the pancreas. So far there are six widely accepted subtypes of MODY described but the list has grown to nine. Although the majority of diabetes mellitus in youth remains type 1 and the incidence of type 2 is rising, MODY should be considered in patients with non-ketotic diabetes at presentation, and in patients with a strong family history of diabetes mellitus without pancreatic auto-antibodies. Furthermore the diagnosis must be confirmed by molecular studies. With advancement in genomic technology, rapid screening for MODY mutations will become readily available in the future.

Figure 1.

Illustration of insulin production by a pancreatic ß cell.

Figure 2.

Family tree of a proband with MODY GCK Subtype.

Figure 3.

Family tree of a proband with MODY HNF1A subtype.

Figure 4.

Algorithm for investigation of hyperglycaemia. DM- Diabetes Mellitus, LADA- Latent Autoimmune Diabetes in Adults, CFRD- Cystic Fibrosis Related Diabetes Mellitus, AD- Autosomal Dominant Inheritance.