A New Tool to Identify Pediatric Patients with Atypical Diabetes Associated with Gene Polymorphisms

• Published in: Diabetes & metabolism journal Vol. 48; no. 5; pp. 949 - 959
• Main Authors: Welsch, Sophie, Harvengt, Antoine, Gallo, Paola, Martin, Manon, Beckers, Dominique, Mouraux, Thierry, Seret, Nicole, Lebrethon, Marie-Christine, Helaers, Raphaël, Brouillard, Pascal, Vikkula, Miikka, Lysy, Philippe A.
• Format: Journal Article Web Resource
• Language: English
• Published: Korea (South) Korean Diabetes Association / Daehan Dangnyobyeong Hakoe 01.09.2024; Korean Diabetes Association; 대한당뇨병학회
• Subjects: Adolescent; Age; Antigens; Body mass index; Child; Child, Preschool; Children & youth; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes mellitus, type 1; Diabetes Mellitus, Type 1 - diagnosis; Diabetes Mellitus, Type 1 - genetics; Diabetes mellitus, type 2; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - genetics; Diagnosis, Differential; Endocrinologie, métabolisme & nutrition; Endocrinology, Diabetes and Metabolism; Endocrinology, metabolism & nutrition; Families & family life; Female; Genetic testing; Glucose; Glycated Hemoglobin; Glycated Hemoglobin - analysis; Human health sciences; Humans; Hyperglycemia; Hypoglycemia; Insulin; Male; Mutation; Original; Patients; Pediatrics; Peptides; Performance evaluation; Polymorphism, Genetic; Pédiatrie; Sciences de la santé humaine; 내과학; Pediatrics; Genetic testing; Diabetes mellitus, type 2; Diabetes mellitus; Diabetes mellitus, type 1
• ISSN: 2233-6079; 2233-6087; 2233-6087
• DOI: 10.4093/dmj.2023.0166

Background: Recent diabetes subclassifications have improved the differentiation between patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus despite several overlapping features, yet without considering genetic forms of diabetes. We sought to facilitate the identification of monogenic diabetes by creating a new tool that we validated in a pediatric maturity-onset diabetes of the young (MODY) cohort.Methods: We first created the DIAgnose MOnogenic DIAbetes (DIAMODIA) criteria based on the pre-existing, but incomplete, MODY calculator. This new score is composed of four strong and five weak criteria, with patients having to display at least one weak and one strong criterion.Results: The effectiveness of the DIAMODIA criteria was evaluated in two patient cohorts, the first consisting of patients with confirmed MODY diabetes (n=34) and the second of patients with T1DM (n=390). These DIAMODIA criteria successfully detected 100% of MODY patients. Multiple correspondence analysis performed on the MODY and T1DM cohorts enabled us to differentiate MODY patients from T1DM. The three most relevant variables to distinguish a MODY from T1DM profile were: lower insulin-dose adjusted A1c score ≤9, glycemic target-adjusted A1c score ≤4.5, and absence of three anti-islet cell autoantibodies.Conclusion: We validated the DIAMODIA criteria, as it effectively identified all monogenic diabetes patients (MODY cohort) and succeeded to differentiate T1DM from MODY patients. The creation of this new and effective tool is likely to facilitate the characterization and therapeutic management of patients with atypical diabetes, and promptly referring them for genetic testing which would markedly improve clinical care and counseling, as well.