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Endocrinología, Diabetes y Nutrición (English ed.)
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MODY 3 diabetes, not every early onset diabetes is type 1 diabetes
Diabetes tipo MODY-3, no todo debut es diabetes tipo 1
María José Sánchez Maloa,
Corresponding author
mjsanchezmalo@gmail.com

Corresponding author.
, Marta Arrudi Morenoa, Gracia María Lou Francésb
a Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Unidad de Diabetes Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hyperglycemia is an increasingly common cause of consultation in paediatrics&#46; Many clinical entities are included under the term of diabetes mellitus&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Type 1 diabetes mellitus is the most common form of childhood diabetes&#46; It represents 95&#37; of all cases of diabetes in Spain among patients under 20 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Maturity onset diabetes of the young &#40;MODY&#41; is a monogenic form of familial early onset diabetes&#46; The diagnosis of MODY requires a high degree of suspicion&#44; with the family history of the patient being taken into account&#46; This disorder is characterized by a dominant autosomal hereditary trait&#44; insulinopenia&#44; and the absence of obesity and insulin resistance and immune markers&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Many patients with MODY are mistakenly diagnosed with type 1 or type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Maturity onset diabetes of the young is the most common type of monogenic diabetes&#46; All known subtypes of MODY are caused by heterozygous mutations in genes that are crucial for the development or proper functioning of the pancreatic &#946; cells&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Developments in molecular genetics have allowed MODY to be classified and diagnosed&#44; with the description to date of at least 14 different genes causing the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The most common subtype in the first two decades of life is MODY-2&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> Patients with the MODY-3 subtype have a more severe defect in insulin secretion&#44; with a greater risk of microvascular complications and a greater need for treatment with oral antidiabetic drugs or insulin&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> For this reason&#44; and since this disease is unusual in paediatrics&#44; we consider it worthwhile to publish the present case&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A male currently 14 years old was attending and referred from another centre where he had been initially diagnosed with type 1 diabetes at 12 years of age&#46; He had blood glucose 203<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in the absence of ketoacidosis&#44; and associated polydipsia&#44; polyuria and a three month history of polyphagia&#44; with no weight loss&#46; Initial glycosylated haemoglobin &#40;HbA1c&#41; was 8&#46;9&#37;&#44; with glycosuria and negative glutamic acid decarboxylase &#40;GAD&#41; antibodies&#46; There was no ketonuria&#46; The celiac disease markers were negative&#44; and the thyroid profile was normal&#46; Microalbuminuria proved negative&#46; The other study findings at the start of diabetes&#44; with cardiological&#44; ophthalmological and neurological evaluations were normal&#46; His body weight was 51<span class="elsevierStyleHsp" style=""></span>kg&#44; with a height of 156<span class="elsevierStyleHsp" style=""></span>cm&#44; and a body mass index &#40;BMI&#41; of 20&#46;96<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; He was at Tanner stage III&#46; The rest of the physical examination proved normal&#46; The patient had a history of hyperglycemic episodes&#44; which were classified as stress hyperglycemia&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The family history revealed type 2 diabetes mellitus in the mother and maternal grandmother&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment was started in the form of multiple-dose insulin with basal insulin &#40;glargine&#41; and bolus insulin &#40;lispro fast-acting insulin analogue&#41;&#44; resulting in acceptable blood glucose levels&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In view of the negative GAD antibodies&#44; the study was completed by having blood samples of the child&#44; mother&#44; maternal grandmother and maternal great uncle sent to the Research Unit of Hospital de Cruces &#40;Bilbao&#44; Spain&#41; for the analysis of insulin autoantibodies&#44; GAD autoantibodies and AI2 autoantibodies&#44; all of which proved negative&#46; The patient has a male sibling three years younger&#44; with apparently normal glycemia&#59; no sample was therefore sent at that time&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">During the follow-up of our patient&#44; which has been irregular due to localization and transport difficulties&#44; there has been a progressive decrease in his insulin requirements while adequate glycemic control has been maintained&#44; with a rapid decrease in HbA1c &#40;5&#46;8&#37; at 4 months&#41;&#46; After negative antibodies were confirmed&#44; and together with the described family history&#44; a MODY study was made&#44; which revealed a heterozygous mutation in exon 4 of the HNF1A gene&#44; consisting of a thiamine duplication in position 789&#46; The mother was also found to present this alteration in heterozygosis&#46; The maternal grandmother and great uncle did not have the mutation&#46; This mutation has not been previously described&#44; but since it results in the formation of an abnormal protein it is likely to be responsible for the disease&#44; this hypotheses being corroborated by the maternal involvement&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">With the confirmed diagnosis of MODY-3&#44; rapid insulin was discontinued&#44; the dose of basal insulin was lowered&#44; and treatment with sulfonylureas &#40;gliclazide&#41; 15<span class="elsevierStyleHsp" style=""></span>mg every 24<span class="elsevierStyleHsp" style=""></span>h with progressive dose increments was started simultaneously&#46; The patient currently maintains adequate HbA1c levels&#46; In the most recent blood test&#44; blood glucose was 135<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; and HbA1c 7&#37;&#44; with a dose increase up to 45<span class="elsevierStyleHsp" style=""></span>mg daily&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient is currently controlled by the diabetes unit of our hospital&#44; with a good clinical course and adequate control of the disease&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">One year later&#44; the male sibling was admitted due to a random blood glucose level of 214<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; glycosuria and HbA1c 8&#37;&#46; Given the background of our patient&#44; and with the suspicion of MODY-3 onset&#44; treatment with sulfonylureas was started&#46; Four days after admission the glycemia values were found to be adequate&#46; The results of the genetic study are pending confirmation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Since MODY-3 is an unusual form of diabetes in paediatric patients&#44; we consider the publication of this case to be of considerable interest&#44; especially as several members of the same family are affected&#46; We underline the importance of clinical suspicion in establishing a proper diagnosis&#44; since it allowed the treatment to be modified and the disease to be adequately controlled&#44; leading to an improvement in patient quality of life&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Collaboration with the Research Unit of Hospital de Cruces &#40;Bilbao&#44; Spain&#41; proved essential in obtaining a correct diagnosis&#46;</p></span>"
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Article information
ISSN: 25300180
Original language: English
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es en pt

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