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Yefet E, Jeda E, Yossef A, Massalha M, Tzur A, Nachum Z. Risk for fetal malformations and unfavorable neonatal outcomes in early-onset gestational diabetes mellitus. J Endocrinol Invest 2024; 47:1181-1190. [PMID: 38042766 DOI: 10.1007/s40618-023-02238-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Early-onset gestational diabetes mellitus (GDM) is diagnosed before the 24th gestational week. Since early GDM is associated with first trimester hyperglycemia, many clinicians treat these women as having pre-GDM. However, whether early GDM increases the risk for unfavorable pregnancy outcomes and particularly for fetal malformations to a greater extent than late-onset GDM were not studied sufficiently. We aimed to examine the effect of early-onset GDM on unfavorable pregnancy outcomes. METHODS A retrospective cohort study of women with GDM delivering singletons during 2005-2018 was conducted. Women were divided into GDM diagnosed at the first (Trimester1; up to 13.6 weeks; N = 117), the second (Trimester2; up to 23.6 weeks; N = 126), and the third trimester (Trimester3; N = 2334). The primary outcomes were neonatal malformations and a composite of large-for-age newborns, hypoglycemia and hyperbilirubinemia treated with phototherapy. Comparisons were made between early- (Trimester1 + Trimester2-groups) and late-onset GDM (Trimester3-group), and between the three trimesters. RESULTS Fetal malformations were low and comparable between the trimester1, trimester2, trimester3 groups (2 (1.7%), 3 (2.4%), and 110 (4.7%), respectively). The composite neonatal complications was similar between the groups (68 (58%), 58 (46%), and 1087 (47%), respectively). In early-onset, the rates of neonatal hypoglycemia and shoulder dystocia were higher than in the late-onset GDM group (OR 95% CI 3.5 [2.0-6.1] and 10.3 [2.4-44.6], respectively). Macrosomia was higher in trimester1 compared with trimester2 and trimester3 cohorts (OR 95% CI 5.3 [1.7-16.9] and 2.8 [1.5-5.2], respectively). CONCLUSIONS The risk for fetal malformations was low and comparable between the first, second and third trimester GDM. Since the risks for macrosomia, shoulder dystocia, and neonatal hypoglycemia are higher in early-onset GDM, these women should undergo strict glycemic control, intensive monitoring, and careful neonatal evaluation.
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Affiliation(s)
- E Yefet
- Department of Obstetrics and Gynecology, Tzafon Medical Center, Poriya, Israel
- Women's Health Center, Clalit Health Services, Afula, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - E Jeda
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - A Yossef
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - M Massalha
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - A Tzur
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Z Nachum
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Yu R, Zhang H, Xiao X. Partial GCK gene deletion mutations causing maturity-onset diabetes of the young. Acta Diabetol 2024; 61:107-115. [PMID: 37704826 DOI: 10.1007/s00592-023-02173-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
AIMS Maturity-onset diabetes of the young (MODY) is an autosomal dominant monogenic form of diabetes, and glucokinase-maturity-onset diabetes of the young (GCK-MODY), or MODY 2, being the most prevalent type. However, the presence of copy number variants (CNVs) may lead to misdiagnoses, as genetic testing for MODY is typically reliant on sequencing techniques. This study aimed to describe the process of diagnosis in a Chinese pedigree with an exon 8-10 deletion of the GCK gene. METHODS This study collected clinical data and medical history through direct interviews with the patient and reviewing relevant medical records. Sanger sequencing and whole exome sequencing (WES) were conducted over years of follow up. WES-based CNV sequencing technology was used to detect CNVs and the results were validated by multiplex ligation-dependent amplification dosage assay (MLPA). Additionally, we reviewed the previously reported cases caused by heterozygous exon deletion of the GCK gene. RESULTS WES-based CNV detection revealed a heterozygous exon 8-10 deletion in the GCK gene within this particular pedigree after Sanger sequencing and WES failed to find causal variants in single nucleotide variations (SNVs) and small indels. The deletion was considered pathogenic according to ACMG/AMP and ClinGen guidelines. Most of the previously reported cases caused by heterozygous exon deletion or whole gene deletion of the GCK gene present similarly to GCK-MODY caused by SNVs and small indels. CONCLUSIONS This study contributed to progress in our comprehension of the mutation spectrum of the GCK gene and underscored the significance of CNV detection in the genetic testing of MODY.
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Affiliation(s)
- Ruiqi Yu
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haichen Zhang
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
- The Beijing Genomics Institute-Research, Beijing, 100101, China
| | - Xinhua Xiao
- Key Laboratory of Endocrinology of National Health Commission, Diabetes Research Center of Chinese Academy of Medical Sciences, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Ren Q, Wang Z, Yang W, Han X, Ji L. Maternal and Infant Outcomes in GCK-MODY Complicated by Pregnancy. J Clin Endocrinol Metab 2023; 108:2739-2746. [PMID: 37011183 DOI: 10.1210/clinem/dgad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
CONTEXT Challenges exist in the management of Glucokinase-maturity-onset diabetes of the young (GCK-MODY), especially during pregnancy. OBJECTIVE This work aimed to evaluate the prevalence of congenital anomaly in newborns from GCK-MODY mothers, and the relationship between fetus genotype and the risk of congenital malformation as well as other adverse pregnancy outcomes. METHODS Electronic databases including PubMed, EMBASE, and Cochrane database last updated July 16, 2022, were searched. We included observational studies conducted in GCK-MODY complicated by pregnancy, and reporting at least one pregnancy outcome. We extracted data in duplicate, and the risk of bias was evaluated by the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analysis was performed by Cochrane Review Manager. RESULTS Eight studies were selected in the meta-analysis. Five were of high quality and 3 were of medium quality evaluated by NOS. A total of 257 GCK-MODY mothers and 499 offspring were enrolled. Among them, 370 offspring were divided into 2 groups: GCK-affected offspring (GCK+, n = 238) and GCK-unaffected offspring (GCK-, n = 132). The percentage of congenital malformations in GCK pregnant women's offspring was 2.4%. The risk of congenital malformations was similar between the GCK+ and GCK- group (odds ratio = 0.56; 95% CI, 0.07-4.51; I2 = 0%; P = .59). The risk of macrosomia/large for gestational age, neonatal hypoglycemia, and combined adverse neonatal outcome was significantly lower in offspring with the GCK mutation compared with non-GCK mutation carriers. CONCLUSION The percentage of congenital malformations was 2.4% in GCK-MODY pregnant women's offspring, and newborns with the GCK mutation have lower birth complication than non-GCK mutation carriers.
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Affiliation(s)
- Qian Ren
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xicheng District, Beijing 100044, People's Republic of China
| | - Zhihui Wang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xicheng District, Beijing 100044, People's Republic of China
| | - Wenjia Yang
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xicheng District, Beijing 100044, People's Republic of China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xicheng District, Beijing 100044, People's Republic of China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Xicheng District, Beijing 100044, People's Republic of China
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Lanza M, Mozzillo E, Boccia R, Fedi L, Di Candia F, Tinto N, Melillo P, Simonelli F, Franzese A. Analysis of Corneal Deformation in Paediatric Patients Affected by Maturity Onset Diabetes of the Young Type 2. Diagnostics (Basel) 2023; 13:diagnostics13081500. [PMID: 37189601 DOI: 10.3390/diagnostics13081500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND To evaluate corneal deformation in Maturity Onset Diabetes of the Young type 2 (MODY2), paediatric subjects were analysed using a Scheimpflug-based device. The purpose of this analysis was to find new biomarkers for MODY2 disease and to gain a better understanding of the pathogenesis of the disease. METHODS A total of 15 patients with genetic and metabolic diagnoses of MODY2 (mean age 12.8 ± 5.66 years) and 15 age-matched healthy subjects were included. The biochemical and anthropometric data of MODY2 patients were collected from clinical records, and a complete ophthalmic check with a Pentacam HR EM-3000 Specular Microscope and Corvis ST devices was performed in both groups. RESULTS Highest concavity (HC) deflection length, Applanation 1 (A1) deflection amplitude, and A1 deflection area showed significantly lower values in MODY2 patients compared to healthy subjects. A significant positive correlation was observed between Body Mass Index (BMI) and HC deflection area and between waist circumference (WC) and the following parameters: maximum deformation amplitude, HC deformation amplitude, and HC deflection area. The glycosylated hemoglobin level (HbA1c) showed a significant positive correlation with Applanation 2 time and HC time. CONCLUSIONS The obtained results show, for the first time, differences regarding corneal distortion features in the MODY2 population compared with healthy eyes.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Enza Mozzillo
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Rosa Boccia
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Ludovica Fedi
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Francesca Di Candia
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, CEINGE Advanced Biotechnologies, Federico II University of Naples, 80131 Naples, Italy
| | - Paolo Melillo
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Francesca Simonelli
- Multidisciplinary Department of Medical Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Adriana Franzese
- Department of Translational Medical Sciences, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80131 Naples, Italy
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The Pathogenic Diagnosis in Pediatric Diabetology: Next Generation Sequencing and Precision Therapy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020310. [PMID: 36837511 PMCID: PMC9964636 DOI: 10.3390/medicina59020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
In pediatric diabetology, a precise diagnosis is very important because it allows early and correct clinical management of the patient. Monogenic diabetes (MD), which accounts for 1-6% of all pediatric-adolescent diabetes cases, is the most relevant example of precision medicine. The definitive diagnosis of MD, possible only by genetic testing, allows us to direct patients to more appropriate therapy in relation to the identified mutation. In some cases, MD patients can avoid insulin and be treated with oral hypoglycemic drugs with a perceptible impact on both the quality of life and the healthcare costs. However, the genetic and phenotypic heterogeneity of MD and the overlapping clinical characteristics between different forms, can complicate the diagnostic process. In recent years, the development of Next-Generation Sequencing (NGS) methodology, which allows the simultaneous analysis of multiple genes, has revolutionized molecular diagnostics, becoming the cornerstone of MD precision diagnosis. We report two cases of patients with clinical suspects of MD in which a genetic test was carried out, using a NGS multigenic panel, and it clarified the correct pathogenesis of diabetes, allowing us to better manage the disease both in probands and other affected family members.
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The Challenges of Treating Glucokinase MODY during Pregnancy: A Review of Maternal and Fetal Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105980. [PMID: 35627517 PMCID: PMC9141824 DOI: 10.3390/ijerph19105980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023]
Abstract
Background: The optimal treatment strategy for the follow-up and management of women with glucokinase maturity-onset diabetes of the young (GCK−MODY)during pregnancy remains unknown. Data regarding maternal and fetal outcomes are lacking. Aim: This paper summarizes the existing literature regarding the maternal and fetal outcomes of women with glucokinase MODY to guide future treatment strategy. Methods: A literature search was conducted in Pubmed, Embace, and Cochrane library with citation follow-up using the terms: glucokinase, MODY, diabetes, pregnancy, gestation, and outcomes. We searched for articles with known fetal mutational status. Relevant outcomes included: birthweight, large for gestational age (LGA), small for gestational age (SGA), macrosomia, cesarean delivery (CD), shoulder dystocia, congenital anomalies, miscarriages, preterm births, and long-term outcomes. Results: Fourteen relevant manuscripts were identified describing maternal and fetal outcomes. The percentage of LGA and macrosomia in 102 glucokinase -unaffected offspring (GCK−) was significantly higher than in the glucokinase -affected offspring (GCK+) (44% vs. 10%, p < 0.001 and 22% vs. 2%, p < 0.001, respectively). Among the 173 GCK(+) offspring, only 5% were SGA, which can be expected according to the normal distribution. We observed higher rates of CD and shoulder dystocia in the GCK(−) offspring. Conclusions: GCK(−) offspring have significantly higher birthweights and more birth complications. The optimal treatment strategy to guide management should take into consideration multiple variables other than fetal mutational status.
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NGS Analysis Revealed Digenic Heterozygous GCK and HNF1A Variants in a Child with Mild Hyperglycemia: A Case Report. Diagnostics (Basel) 2021; 11:diagnostics11071164. [PMID: 34202200 PMCID: PMC8306687 DOI: 10.3390/diagnostics11071164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Monogenic diabetes (MD) represents a heterogeneous group of disorders whose most frequent form is maturity-onset diabetes of the young (MODY). MD is predominantly caused by a mutation in a single gene. We report a case of a female patient with suspected MD and a positive family history for diabetes and obesity. In this patient, two gene variants have been identified by next-generation sequencing (NGS): one in the Glucokinase (GCK) gene reported in the Human Gene Mutation Database (HGMD) and in the literature associated with GCK/MODY, and the other in the hepatocyte nuclear factor 1A (HNF1A) gene not previously described. The GCK variant was also identified in the hyperglycemic father, whereas the HNF1A variant was present in the mother. This new case of digenic GCK/HNF1A variants identified in a hyperglycemic subject, evidences the importance of NGS analysis in patients with suspected MD. In fact, this methodology will allow us to both increase the number of diagnoses and to identify mutations in more than one gene, with a better understanding of the genetic cause, and the clinical course, of the disease.
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López Tinoco C, Sánchez Lechuga B, Bacon S, Colclough K, Ng N, Wong E, Goulden EL, Edwards J, Fleming A, Byrne B, Byrne MM. Evaluation of pregnancy outcomes in women with GCK-MODY. Diabet Med 2021; 38:e14488. [PMID: 33277730 DOI: 10.1111/dme.14488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
AIMS To determine the fetal and maternal outcomes in pregnant women with Glucokinase-Maturity onset diabetes of the young (GCK-MODY). METHODS We studied the obstetric and perinatal outcomes in 99 pregnancies of 34 women with GCK-MODY. The mutation status of the offspring was known in 29 and presumed in 33. Clinical outcomes were determined and compared between affected (n = 39) and unaffected (n = 23) offspring. RESULTS 59% of pregnancies were treated with diet alone and 41% received insulin. Birthweight, percentage of large for gestational age (LGA) and caesarean section (CS) in GCK-unaffected offspring was significantly higher than in GCK-affected offspring (4.0 ± 0.7 vs. 3.4 ± 0.4 kg, p = 0.001), 15 (65%) vs. 5(13%) (p = 0.00006) and 17 (74%) vs. 11 (28%) (p = 0.001), respectively. We observed an earlier gestational age at delivery on insulin in unaffected offspring (38.3 ± 1.0 vs. 39.5 ± 1.5 weeks, p = 0.03) with no significant change in LGA (9 (82%) vs. 6 (50%); p = 0.12), and a higher rate of CS (8 [73%] vs. 3 [11%]; p < 0.001), and no change in small for gestational age (0 [0%] vs. 4 [14%]; p = 0.30) in affected offspring. CONCLUSION Insulin therapy in unaffected offspring did not reduce LGA and was associated with earlier gestational age at delivery. Insulin treatment in GCK-affected offspring was associated with an increased incidence of CS, but did not adversely affect fetal outcome. Fetal genotype determines birthweight rather than treatment. Pre-pregnancy diagnosis of GCK-MODY, use of continuous glucose monitoring and non-invasive fetal genotyping may enable further investigation of targeted therapy in this condition.
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Affiliation(s)
| | - Begoña Sánchez Lechuga
- Department of Endocrinology, Puerta del Mar University Hospital, Cádiz, Spain
- Department of Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Siobhan Bacon
- Department of Endocrinology, Sligo University Hospital, Sligo, Ireland
| | - Kevin Colclough
- Department of Molecular Genetics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicholas Ng
- Department of Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eleanor Wong
- Department of Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eirena L Goulden
- Department of Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- Rotunda Maternity Hospital, Dublin, Ireland
| | | | | | - Bridgette Byrne
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Maria M Byrne
- Department of Endocrinology, Mater Misericordiae University Hospital, Dublin, Ireland
- Rotunda Maternity Hospital, Dublin, Ireland
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Iafusco F, Meola S, Pecoraro C, Mazzaccara C, Iafusco D, Tinto N. Prenatal diagnosis of HNF1b mutation allows recognition of neonatal dysglycemia. Acta Diabetol 2021; 58:393-395. [PMID: 33259036 PMCID: PMC7906928 DOI: 10.1007/s00592-020-01641-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Fernanda Iafusco
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | - Serena Meola
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | | | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy
- CEINGE Advanced Biotechnology, Naples, Italy
| | - Dario Iafusco
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II", Naples, Italy.
- CEINGE Advanced Biotechnology, Naples, Italy.
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Maternal or Paternal Diabetes and Its Crucial Role in Offspring Birth Weight and MODY Diagnosis. Metabolites 2020; 10:metabo10100387. [PMID: 32998381 PMCID: PMC7601484 DOI: 10.3390/metabo10100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/26/2020] [Indexed: 11/17/2022] Open
Abstract
Maturity-onset diabetes of the young (MODY) represents a heterogenous group of monogenic autosomal dominant diseases, which accounts for 1-2% of all diabetes cases. Pregnancy represents a crucial time to diagnose MODY forms due to the 50% risk of inheritance in offspring of affected subjects and the potential implications on adequate fetal weight. Not only a history of maternal diabetes may affect the birth weight of offspring, paternal diabetes should also be taken into consideration for a correct pathogenetic diagnosis. The crucial role of maternal and paternal diabetes inheritance patterns and the impact of this inherited mutation on birthweight and the MODY diagnosis was discussed.
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Iafusco D, Zanfardino A, Bonfanti R, Rabbone I, Tinto N, Iafusco F, Meola S, Gicchino MF, Ozen G, Casaburo F, Piscopo A, Miraglia Del Giudice E, Barbetti F. Congenital diabetes mellitus. Minerva Pediatr 2020; 72:240-249. [PMID: 32274916 DOI: 10.23736/s0026-4946.20.05838-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital diabetes mellitus is a rare disorder characterized by hyperglycemia that occurs shortly after birth. We define "Diabetes of Infancy" if hyperglycemia onset before 6 months of life. From the clinical point of view, we distinguish two main types of diabetes of infancy: transient (TNDM), which remits spontaneously, and permanent (PNDM), which requires lifelong treatment. TNDM may relapse later in life. About 50% of cases are transient (TNDM) and 50% permanent. Clinical manifestations include severe intrauterine growth retardation, hyperglycemia and dehydration. A wide range of different associated clinical signs including facial dysmorphism, deafness and neurological, cardiac, kidney or urinary tract anomalies are reported. Developmental delay and learning difficulties may also be observed. In this paper we review all the causes of congenital diabetes and all genes and syndromes involved in this pathology. The discovery of the pathogenesis of most forms of congenital diabetes has made it possible to adapt the therapy to the diagnosis and in the forms of alteration of the potassium channels of the pancreatic Beta cells the switch from insulin to glibenclamide per os has greatly improved the quality of life. Congenital diabetes, although it is a very rare form, has been at the must of research in recent years especially for pathogenesis and pharmacogenetics. The most striking difference compared to the more frequent autoimmune diabetes in children (type 1 diabetes) is the possibility of treatment with hypoglycemic agents and the apparent lower frequency of chronic complications.
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Affiliation(s)
- Dario Iafusco
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy -
| | - Angela Zanfardino
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Riccardo Bonfanti
- Unit of Pediatric Diabetology, Department of Pediatrics, Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Ivana Rabbone
- Hub Regional Center of Pediatric Diabetology, Department of Science of Health, Maggiore della Carità University Hospital, University of Eastern Piedmont, Novara, Italy
| | - Nadia Tinto
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Fernanda Iafusco
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Serena Meola
- CEINGE Advanced Biotechnologies, Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - Maria F Gicchino
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gulsum Ozen
- Department of Pediatrics, University of Health Science, Ankara Training and Research Hospital, Ankara, Turkey
| | - Francesca Casaburo
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessia Piscopo
- Department of Pediatrics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Fabrizio Barbetti
- Department of Experimental Medicine, Tor Vergata University, Rome, Italy
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Affiliation(s)
- Miriam S Udler
- From the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Massachusetts General Hospital, and the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Harvard Medical School - both in Boston
| | - Camille E Powe
- From the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Massachusetts General Hospital, and the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Harvard Medical School - both in Boston
| | - Christina A Austin-Tse
- From the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Massachusetts General Hospital, and the Departments of Medicine (M.S.U., C.E.P.) and Pathology (C.A.A.-T.), Harvard Medical School - both in Boston
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Vitacolonna E, Succurro E, Lapolla A, Scavini M, Bonomo M, Di Cianni G, Di Benedetto A, Napoli A, Tumminia A, Festa C, Lencioni C, Torlone E, Sesti G, Mannino D, Purrello F. Guidelines for the screening and diagnosis of gestational diabetes in Italy from 2010 to 2019: critical issues and the potential for improvement. Acta Diabetol 2019; 56:1159-1167. [PMID: 31396699 DOI: 10.1007/s00592-019-01397-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/30/2019] [Indexed: 12/17/2022]
Abstract
AIMS In 2010, Italian health professionals rapidly implemented the one-step screening for gestational diabetes mellitus (GDM) based on a 75 g OGTT, to comply with the diagnostic criteria proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). The change was promoted by the two main Italian scientific societies of diabetology, Associazione Medici Diabetologi (AMD) and Società Italiana di Diabetologia (SID), and it took just a few months for the Istituto Superiore di Sanità, together with several scientific societies, to revise the criteria and include them in the National Guidelines System. Over the last 9 years, the implementation of these guidelines has shown some benefits and some drawbacks. METHODS In order to evaluate the critical issues arisen from the implementation of the current Italian guidelines for the diagnosis of GDM, the studies published on this topic have been reviewed. The search was performed using the following keywords: "gestational diabetes" AND "diagnostic criteria" OR screening AND Ital*. The study is an expert opinion paper, based on the relevant scientific literature published between 2010 and 2019. The databases screened for the literature review included PubMed, MEDLINE, and Scopus. RESULTS The implementation of the Guidelines for Screening and Diagnosis of GDM in Italy present some strengths and some weaknesses. One of the positive aspects is that high-risk women are required to perform an OGTT early in pregnancy. By contrast, there are several aspects in need of improvement: (1) In spite of the current indications, only a minority of high-risk women perform OGTT early in pregnancy; (2) several low-risk women are screened for GDM; (3) in some low-risk women affected by GDM, the diagnosis might be missed with the application of the current guidelines; (4) there is a lack of homogeneity in the risk assessment data from different regions. CONCLUSIONS In order to improve the current Italian GDM guidelines, some practical solutions have been suggested.
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Affiliation(s)
- Ester Vitacolonna
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy.
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy.
- Department of Medicine and Aging, School of Medicine and Health Sciences, "G. d'Annunzio" University, Chieti-Pescara, Chieti, Italy.
| | - Elena Succurro
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Annunziata Lapolla
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Medicine, Diabetology and Dietetics Unit, Padova University, Padua, Italy
| | - Marina Scavini
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Division of Immunology, Transplantation and Infectious Diseases, Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Bonomo
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- SSD Diabetology, Ca'Granda Niguarda Hospital, Milan, Italy
| | - Graziano Di Cianni
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Diabetes and Metabolic Diseases Unit, Health Local Unit Nord-West Tuscany, Livorno Hospital, Leghorn, Italy
| | - Antonino Di Benedetto
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Angela Napoli
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Andrea Tumminia
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Camilla Festa
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Department of Experimental Medicine, Faculty of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Cristina Lencioni
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Diabetes Unit, Usl Nord Ovest Tuscany, Lucca, Italy
| | - Elisabetta Torlone
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Internal Medicine, Endocrinology and Metabolism, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giorgio Sesti
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Italian Diabetes and Research Foundation, Italian Society of Diabetology (SID), Rome, Italy
| | - Domenico Mannino
- Diabetes and Pregnancy Study Group, Italian Society of Diabetology (SID), Rome, Italy
- Diabetes and Pregnancy Study Group, Italian Association of Diabetologists (AMD), Rome, Italy
- Section of Endocrinology and Diabetes, Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
- Italian Association of Diabetologists (AMD), Rome, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Italian Society of Diabetology (SID), Rome, Italy
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Monsonego S, Clark H, Karovitch A, O'Meara P, Shaw T, Malcolm J. Management and Outcomes of Maturity-Onset Diabetes of the Young in Pregnancy. Can J Diabetes 2019; 43:647-654. [PMID: 31564623 DOI: 10.1016/j.jcjd.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 02/08/2023]
Abstract
Maturity-onset diabetes of the young (MODY) is a group of monogenic disorders that accounts for 1% to 5% of diabetes. The most common mutations are those in the hepatocyte nuclear factor-1-alpha (HNF-1-alpha) and in the glucokinase (GCK) genes. Although management of MODY is well established, no guidelines currently exist for management during pregnancy. Both maternal glycemic control and fetal mutation status are factors that may influence outcomes during pregnancy. The primary aim of this project was to describe cases of MODY during pregnancy to highlight the clinical implications of management of this disorder during pregnancy. The Ottawa Hospital is the primary referral centre for high-risk obstetrical patients, including those with diabetes in pregnancy, in Ottawa, Canada. Referrals between 2008 and 2018 were reviewed and a case series of three women and five pregnancies is described. Together with the illustrative cases, a literature review of MODY in pregnancy is used to highlight clinical considerations unique to MODY in pregnancy. We describe 5 pregnancies with MODY-2 (GCK mutation) and MODY 3 (HNF-1-alpha mutation). Important issues identified included monitoring of fetal growth and individualization of maternal glycemic control, particularly in cases where fetal mutation status is unknown. Management of MODY in pregnancy is challenging and there is little evidence to guide recommendations. Fetal growth can be used to guide management of maternal glycemic targets when fetal mutation status is unknown.
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Affiliation(s)
- Sarah Monsonego
- Division of Endocrinology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Heather Clark
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Karovitch
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paloma O'Meara
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tammy Shaw
- Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janine Malcolm
- Division of Endocrinology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Wang X, Wang T, Yu M, Zhang H, Ping F, Zhang Q, Xu J, Feng K, Xiao X. Screening of HNF1A and HNF4A mutation and clinical phenotype analysis in a large cohort of Chinese patients with maturity-onset diabetes of the young. Acta Diabetol 2019; 56:281-288. [PMID: 30293189 DOI: 10.1007/s00592-018-1232-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022]
Abstract
AIMS The study aimed to screen the HNF1A and HNF4A mutation in a large Chinese cohort of high clinical suspicion of maturity-onset diabetes of the young (MODY) patients and characterize the clinical features of those patients. The performance of hsCRP as a biomarker to differentiate MODY3 from early onset T2DM was also evaluated. METHODS A total of 74 patients with a strong clinical suspicion of MODY from 59 families and 33 newly diagnosed early-onset T2DM were included. HNF1A and HNF4A mutations were analyzed by Sanger sequencing. ROC curves were used to identify the optimal cutoff of hsCRP. RESULTS One novel (c.864_865insG) and six recurrent HNF1A mutations (R203H, R263H, P379T, L422P, P519L and c.873delC) in 17 patients from 8 families (13.6%), as well as one novel HNF4A (R331H) mutation were identified. Nonspecific clinical presentations were observed in MODYX compared to MODY3 patients. MODY3 subjects exhibited with younger, lower BMI, TG, fasting and postprandial C-peptide, higher HDL than T2DM. Particularly, we confirmed serum hsCRP was lower in MODY3 than T2DM. ROC curve showed a good discrimination with an AUC of 0.852 and identified a cutoff hsCRP of 0.79 (75% sensitivity and 83% specificity). Good glycemic control was observed in all identified patients after switching to glimepiride therapy. CONCLUSIONS The prevalence of HNF1A mutation was relatively lower in Mainland China and HNF4A mutation was rare. Serum hsCRP concentrations performed well in discriminating MODY3 from T2DM. Molecular diagnosis of MODY3/1 did transform management in clinical practice and facilitated the glycemic control.
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Affiliation(s)
- Xiaojing Wang
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Tong Wang
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Miao Yu
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Huabing Zhang
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Fan Ping
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Qian Zhang
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Jianping Xu
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Kai Feng
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China
| | - Xinhua Xiao
- Key Laboratory of Endocrinology, Department of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Diabetes Research Center of Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai fu yuan No.1, Dongcheng District, Beijing, China.
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