Monogenic diabetes:An evidence-based clinical approach  

作　　者：Saptarshi Bhattacharya Cornelius J Fernandez Abul Bashar Mohammad Kamrul-Hasan Joseph M Pappachan 

机构地区：[1]Department of Endocrinology,Indraprastha Apollo Hospitals,Delhi 110076,India [2]Department of Endocrinology and Metabolism,Pilgrim Hospital,United Lincolnshire Hospitals NHS Trust,Boston PE219QS,Lincolnshire,United Kingdom [3]Department of Endocrinology,Mymensingh Medical College,Mymensingh 2200,Bangladesh [4]Faculty of Science,Manchester Metropolitan University,Manchester M156BH,Greater Manchester,United Kingdom [5]Department of Endocrinology,Kasturba Medical College,Manipal Academy of Higher Education,Manipal 576104,India

出　　处：《World Journal of Diabetes》2025年第5期47-70,共24页世界糖尿病杂志(英文)

摘　　要：Monogenic diabetes is a heterogeneous disorder characterized by hyperglycemia arising from defects in a single gene.Maturity-onset diabetes of the young(MODY)is the most common type with 14 subtypes,each linked to specific mutations affecting insulin synthesis,secretion and glucose regulation.Common traits across MODY subtypes include early-onset diabetes,a family history of autosomal dominant diabetes,lack of features of insulin resistance,and absent islet cell autoimmunity.Many cases are misdiagnosed as type 1 and type 2 diabetes mellitus.Biomarkers and scoring systems can help identify candidates for genetic testing.GCK-MODY,a common subtype,manifests as mild hyperglycemia and doesn’t require treatment except during pregnancy.In contrast,mutations in HNF4A,HNF1A,and HNF1B genes lead to progressive beta-cell failure and similar risks of complications as type 2 diabetes mellitus.Neonatal diabetes mellitus(NDM)is a rare form of monogenic diabetes that usually presents within the first six months.Half of the cases are lifelong,while others experience transient remission.Permanent NDM is most commonly due to activating mutations in genes encoding the adenosine triphosphate-sensitive potassium channel(KCNJ11 or ABCC8)and can be transitioned to sulfonylurea after confirmation of diagnosis.Thus,in many cases,monogenic diabetes offers an opportunity to provide precision treatment.The scope has broadened with next-generation sequencing(NGS)technologies,replacing older methods like Sanger sequencing.NGS can be for targeted gene panels,whole-exome sequencing(WES),or whole-genome sequencing.Targeted gene panels offer specific information efficiently,while WES provides comprehensive data but comes with bioinformatic challenges.The surge in testing has also led to an increase in variants of unknown significance(VUS).Deciding whether VUS is disease-causing or benign can be challenging.Computational models,functional studies,and clinical knowledge help to determine pathogenicity.Advances in genetic testing technologies offer

关 键 词：Monogenic diabetes Maturity-onset diabetes of the young Neonatal diabetes Mitochondrial diabetes Insulin resistance syndrome Monogenic autoimmune diabetes Next-generation sequencing 

分 类 号：R587.1[医药卫生—内分泌]