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48. How to treat patients with MODY?

The basic pathophysiological defect in patients with MODY is β-cell dysfunc-

tion (rather than insulin resistance), and some subtypes of MODY are extremely

sensitive to sulfonylureas. Therefore, the treatment of choice in patients with

MODY is sulfonylureas. As insulin sensitivity is normal, insulin sensitizers

have no role in patients with MODY. Patients with MODY 2 have mild hyper-

glycemia and usually respond to lifestyle modification, while those with MODY

1 and 3 require sulfonylureas for glycemic control; however, one- third of

patients with MODY 1 and 3 may require insulin. In addition, glinides have

also been used in patients with MODY 3 with favorable results. Patients with

MODY 10 require insulin as they have insulin gene defect. There are anecdotal

reports of the use of DPP4 inhibitor/GLP1 receptor agonists in the management

of MODY 3 (HNF-1α) with limited benefits.

49. What is latent autoimmune diabetes of adults?

Latent autoimmune diabetes of adults (LADA) is also known as type 1.5 diabe-

tes as it shares features of both T1DM and T2DM. The onset of diabetes after

30 years of age, non-requirement of insulin for at least 6 months after the diag-

nosis, and evidence of islet cell autoimmunity are the characteristic features of

LADA. However, some individuals may present between 25 and 35 years of

age as shown in the landmark United Kingdom Prospective Diabetes Study

(UKPDS). These individuals are often diagnosed to have type 2 diabetes and

started on oral antidiabetic drugs; however, most of these individual will require

insulin within a few years.

50. What are the differentiating features between T1DM and LADA?

The differentiating features between T1DM and LADA are summarized in the

table given below.

Parameters T1DM LADA

Age of onset Childhood Young adults (>30 years)

Presentation with

DKA

Common Rare

Insulin dependence Since diagnosis Usually after 6 months of

diagnosis

HLA association HLA DR 3, DR 4 (increased

expression of destructive

genotype)

HLA DQ A1, B1 (decreased

expression of protective genotype)

Islet autoimmunity Multiple autoantibodies (≥2)

present at diagnosis

Usually single autoantibody
positive (GAD65 or ICA)a
aGAD65 glutamic acid decarboxylase, ICA islet cell autoantibody

12 Diabetes in the Young