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Successful maintenance on sulphonylurea therapy and low diabetes complication rates in a HNF1A–MODY cohort
Author(s) -
Bacon S.,
Kyithar M. P.,
Rizvi S. R.,
Donnelly E.,
McCarthy A.,
Burke M.,
Colclough K.,
Ellard S.,
Byrne M. M.
Publication year - 2016
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 - 10.1111/dme.12992
Subject(s) - medicine , cohort , diabetes mellitus , hnf1a , maturity onset diabetes of the young , type 2 diabetes mellitus , type 2 diabetes , microalbuminuria , endocrinology , cohort study
Aims HNF1A gene mutations are the most common cause of maturity‐onset diabetes of the young ( MODY ) in the UK . Persons with HNF 1A– MODY display sensitivity to sulphonylurea therapy; however, the long‐term efficacy is not established. There is limited literature as to the prevalence of micro‐ and macrovascular complications in this unique cohort. The aim of this study was to determine the natural progression and clinical management of HNF 1A– MODY diabetes in a dedicated MODY clinic. Methods Sixty patients with HNF 1A– MODY and a cohort of 60 BMI ‐, age‐, ethnicity‐ and diabetes duration‐matched patients with Type 1 diabetes mellitus participated in the study. All patients were phenotyped in detail. Clinical follow‐up of the HNF 1A– MODY cohort occurred on a bi‐annual basis. Results Following a genetic diagnosis of MODY , the majority of the cohort treated with sulphonylurea therapy remained insulin independent at 84–month follow‐up (80%). The HbA 1c in the HNF 1A– MODY group treated with sulphonylurea therapy alone improved significantly over the study period [from 49 (44–63) mmol/mol, 6.6 (6.2–7.9)% to 41 (31–50) mmol/mol, 5.9 (5–6.7)%; P = 0.003]. The rate of retinopathy was significantly lower than that noted in the Type 1 diabetes mellitus group (13.6 vs. 50%; P = 0.0001).There was also a lower rate of microalbuminuria and cardiovascular disease in the HNF 1A– MODY group compared with the Type 1 diabetes mellitus group. Conclusions This study demonstrates that the majority of patients with HNF 1A– MODY can be maintained successfully on sulphonylurea therapy with good glycaemic control. We note a significantly lower rate of micro‐ and macrovascular complications than reported previously. The use of appropriate therapy at early stages of the disorder may decrease the incidence of complications.