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Heterogeneity in young adult onset diabetes: aetiology alters clinical characteristics
Author(s) -
Owen K. R.,
Shepherd M.,
Stride A.,
Ellard S.,
Hattersley A. T.
Publication year - 2002
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2002.00766.x
Subject(s) - medicine , diabetes mellitus , body mass index , endocrinology , family history , type 2 diabetes , age of onset , gastroenterology , etiology , young adult , disease
Aims To describe the characteristics of hepatocyte nuclear factor (HNF) 1α mutation carriers diagnosed with diabetes after 25 years and compare them with young‐onset Type 2 diabetic patients (YT2D) diagnosed at the same age. Subjects and methods We studied 44 (21 male, 23 female) patients with HNF‐1α mutations diagnosed with diabetes at ages 25–45 years and 44 YT2D subjects matched for sex and age of diagnosis. Results Median age of onset of diabetes was 35 years in both groups. The HNF‐1α group demonstrated: lower body mass index (25.1 vs. 30.7 kg/m 2 ; P < 0.001) and lower fasting triglycerides (1.37 vs. 2.96 mmol/l; P = 0.001) with similar fasting cholesterol level. They had lower glycated haemoglobin A 1c (7.3 vs. 8.5%; P = 0.015) despite greater duration of diabetes (24 vs. 16 years; P = 0.02) and less frequent treatment with insulin (21% vs. 55%; P = 0.002). They were less likely to be treated for hypertension (13.3% vs. 56.3%; P = 0.009). Importantly, no difference was observed in reported parental history of diabetes between the two groups (65.9% vs. 63.6%; P = 0.92). Logistic regression showed that triglyceride levels and presence of anti‐hypertensive treatment were the most important independent variables. Conclusions Patients with HNF‐1α mutations may present with diabetes as young adults between the ages of 25–45 years. In this age range a wide differential diagnosis of diabetes is observed. Conventional criteria of age of onset and family history will not differentiate HNF‐1α mutation carriers from YT2D subjects in this age range, but features of the metabolic syndrome, in particular fasting triglycerides and hypertension, are helpful. In patients diagnosed before 45 years without features of insulin resistance the diagnosis of HNF‐1α should be considered.