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    Recognition and Management of Individuals With Hyperglycemia Because of a Heterozygous Glucokinase Mutation

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    URI
    http://hdl.handle.net/11287/594015
    Author
    Chakera, Ali J.
    Steele, A. M.
    Gloyn, A. L.
    Shepherd, Maggie
    Shields, Beverley M
    Ellard, Sian
    Hattersley, Andrew T.
    Date
    2015-07
    Journal
    Diabetes care
    Type
    Journal Article
    Research Support, Non-U.S. Gov't
    Review
    Publisher
    Diabetes Care
    DOI
    10.2337/dc14-2769
    Metadata
    Show full item record
    Abstract
    Glucokinase-maturity-onset diabetes of the young (GCK-MODY), also known as MODY2, is caused by heterozygous inactivating mutations in the GCK gene. GCK gene mutations are present in approximately 1 in 1,000 of the population, but most are not diagnosed. They are common causes of MODY (10-60%): persistent incidental childhood hyperglycemia (10-60%) and gestational diabetes mellitus (1-2%). GCK-MODY has a unique pathophysiology and clinical characteristics, so it is best considered as a discrete genetic subgroup. People with GCK-MODY have a defect in glucose sensing; hence, glucose homeostasis is maintained at a higher set point resulting in mild, asymptomatic fasting hyperglycemia (5.4-8.3 mmol/L, HbA1c range 5.8-7.6% [40-60 mmol/mol]), which is present from birth and shows slight deterioration with age. Even after 50 years of mild hyperglycemia, people with GCK-MODY do not develop significant microvascular complications, and the prevalence of macrovascular complications is probably similar to that in the general population. Treatment is not recommended outside pregnancy because glucose-lowering therapy is ineffective in people with GCK-MODY and there is a lack of long-term complications. In pregnancy, fetal growth is primarily determined by whether the fetus inherits the GCK gene mutation from their mother. Insulin treatment of the mother is only appropriate when increased fetal abdominal growth on scanning suggests the fetus is unaffected. The impact on outcome of maternal insulin treatment is limited owing to the difficulty in altering maternal glycemia in these patients. Making the diagnosis of GCK-MODY through genetic testing is essential to avoid unnecessary treatment and investigations, especially when patients are misdiagnosed with type 1 or type 2 diabetes.
    Citation
    Diabetes Care. 2015 Jul;38(7):1383-92.
    Publisher URL
    http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=26106223
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    • 2015 RD&E publications
    • Diabetes/Endocrine Services
    • Honorary contracts publications
    • Molecular Genetics

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