Abstract
BackgroundThe prevalence of monogenic diabetes is estimated to be 1.1–6.3% of patients with diabetes mellitus (DM) in Europe. The overlapping clinical features of various forms of diabetes make differential diagnosis challenging. Therefore, this study investigated the etiologic distribution and clinical characteristics of pediatric diabetes, including monogenic diabetes, who presented at a single tertiary center over the last 20 years.MethodsThis study included 276 consecutive patients with DM diagnosed before 18 years of age from January 2000 to December 2019 in Korea. Clinical features, biochemical findings, β-cell autoantibodies, and molecular characteristics were reviewed retrospectively.ResultsOf the 276 patients, 206 patients (74.6%), 49 patients (17.8%), and 21 patients (7.6%) were diagnosed with type 1 DM, type 2 DM, and clinically suspected monogenic diabetes, respectively. Among 21 patients suspected to have monogenic diabetes, 8 patients had clinical maturity-onset diabetes of the young (MODY), and the remaining 13 patients had other types of monogenic diabetes. Among them, genetic etiologies were identified in 14 patients (5.1%) from 13 families, which included MODY 5, transient neonatal DM, developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome, Wolfram syndrome, Donohue syndrome, immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, Fanconi-Bickel syndrome, Wolcott-Rallison syndrome, cystic fibrosis-related diabetes, and maternally inherited diabetes and deafness.ConclusionsGenetically confirmed monogenic diabetes accounted for 5.1% of patients evaluated at a single tertiary center over 20-year period. Based on the findings for our sample, the frequency of mutations in the major genes of MODY appears to be low among pediatric patients in Korea. It is critical to identify the genetic cause of DM to provide appropriate therapeutic options and genetic counseling.
Highlights
The prevalence of monogenic diabetes is estimated to be 1.1–6.3% of patients with diabetes mellitus (DM) in Europe
Clinical and molecular characteristics of patients with type 1 and type 2 diabetes mellitus Of the 276 patients, 206 (74.6%), 49 (17.8%), and 21 (7.6%) patients were diagnosed with type 1 DM, type 2 DM, and clinically suspected monogenic diabetes, respectively (Fig. 1)
Trend of frequency of new diabetes cases is detailed in Fig. 2; in particular, the frequency of type 2 DM increased during the study period
Summary
The prevalence of monogenic diabetes is estimated to be 1.1–6.3% of patients with diabetes mellitus (DM) in Europe. Among children and adolescents with diabetes mellitus (DM), type 1 DM is the most common, especially in North America and Europe [1]. Compared with type 2 DM, monogenic diabetes, including maturity-onset diabetes of the young (MODY), is a rare form of DM caused by mutations in one of more than 20 genes that control either the secretion or action of insulin [6]. The prevalence of monogenic diabetes is estimated to be 1.1–6.3% among children and adolescents with DM in Europe [8,9,10,11,12,13]
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