Systematic Population Screening, Using Biomarkers and Genetic Testing, Identifies 2.5% of the U.K. Pediatric Diabetes Population With Monogenic Diabetes

Diabetes Care. 2016 Nov;39(11):1879-1888. doi: 10.2337/dc16-0645. Epub 2016 Jun 6.

Abstract

Objective: Monogenic diabetes is rare but is an important diagnosis in pediatric diabetes clinics. These patients are often not identified as this relies on the recognition of key clinical features by an alert clinician. Biomarkers (islet autoantibodies and C-peptide) can assist in the exclusion of patients with type 1 diabetes and allow systematic testing that does not rely on clinical recognition. Our study aimed to establish the prevalence of monogenic diabetes in U.K. pediatric clinics using a systematic approach of biomarker screening and targeted genetic testing.

Research design and methods: We studied 808 patients (79.5% of the eligible population) <20 years of age with diabetes who were attending six pediatric clinics in South West England and Tayside, Scotland. Endogenous insulin production was measured using the urinary C-peptide creatinine ratio (UCPCR). C-peptide-positive patients (UCPCR ≥0.2 nmol/mmol) underwent islet autoantibody (GAD and IA2) testing, with patients who were autoantibody negative undergoing genetic testing for all 29 identified causes of monogenic diabetes.

Results: A total of 2.5% of patients (20 of 808 patients) (95% CI 1.6-3.9%) had monogenic diabetes (8 GCK, 5 HNF1A, 4 HNF4A, 1 HNF1B, 1 ABCC8, 1 INSR). The majority (17 of 20 patients) were managed without insulin treatment. A similar proportion of the population had type 2 diabetes (3.3%, 27 of 808 patients).

Conclusions: This large systematic study confirms a prevalence of 2.5% of patients with monogenic diabetes who were <20 years of age in six U.K. clinics. This figure suggests that ∼50% of the estimated 875 U.K. pediatric patients with monogenic diabetes have still not received a genetic diagnosis. This biomarker screening pathway is a practical approach that can be used to identify pediatric patients who are most appropriate for genetic testing.

MeSH terms

  • Adolescent
  • Antigens, CD / genetics
  • Autoantibodies / immunology
  • Biomarkers
  • C-Peptide / metabolism
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / diagnosis*
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / metabolism
  • Diabetes Mellitus, Type 2 / diagnosis*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / genetics
  • Diagnosis, Differential
  • England / epidemiology
  • Female
  • Genetic Testing
  • Germinal Center Kinases
  • Hepatocyte Nuclear Factor 1-alpha / genetics
  • Hepatocyte Nuclear Factor 1-beta / genetics
  • Hepatocyte Nuclear Factor 4 / genetics
  • Humans
  • Infant
  • Male
  • Prevalence
  • Protein-Serine-Threonine Kinases / genetics
  • Receptor, Insulin / genetics
  • Scotland / epidemiology
  • Sequence Analysis, DNA
  • Sulfonylurea Receptors / genetics
  • Young Adult

Substances

  • ABCC8 protein, human
  • Antigens, CD
  • Autoantibodies
  • Biomarkers
  • C-Peptide
  • Germinal Center Kinases
  • HNF1A protein, human
  • HNF1B protein, human
  • HNF4A protein, human
  • Hepatocyte Nuclear Factor 1-alpha
  • Hepatocyte Nuclear Factor 4
  • Sulfonylurea Receptors
  • Hepatocyte Nuclear Factor 1-beta
  • INSR protein, human
  • Receptor, Insulin
  • Protein-Serine-Threonine Kinases

Supplementary concepts

  • Maturity-Onset Diabetes of the Young, Type 1
  • Maturity-Onset Diabetes of the Young, Type 2
  • Maturity-Onset Diabetes of the Young, Type 3
  • Maturity-Onset Diabetes of the Young, Type 4