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Traditional clinical criteria outperform high-sensitivity C-reactive protein for the screening of hepatic nuclear factor 1 alpha maturity-onset diabetes of the young among young Asians with diabetes.

Authors
  • Rama Chandran, Suresh1
  • Bhalshankar, Jaydutt2
  • Farhad Vasanwala, Rashida3
  • Zhao, Yi4
  • Owen, Katharine R5
  • Su-Lyn Gardner, Daphne6
  • 1 Department of Endocrinology, Singapore General Hospital, Singapore. , (Singapore)
  • 2 National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore. , (Singapore)
  • 3 Department of Paediatrics, KK Women's and Children's Hospital, Singapore. , (Singapore)
  • 4 Division of Clinical Research, Singapore General Hospital, Singapore. , (Singapore)
  • 5 Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK Oxford National Institute for Health Research Biomedical Research Centre, The Churchill Hospital, Oxford, UK.
  • 6 Department of Endocrinology, Singapore General Hospital, 20 College Road, 169856, Singapore. , (Singapore)
Type
Published Article
Journal
Therapeutic advances in endocrinology and metabolism
Publication Date
Sep 01, 2018
Volume
9
Issue
9
Pages
271–282
Identifiers
DOI: 10.1177/2042018818776167
PMID: 30181854
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Young adults with diabetes in Asia represent a heterogeneous group. Using traditional clinical criteria to preselect individuals for testing for maturity-onset diabetes of the young (MODY) may exclude a large proportion from testing. High-sensitivity C-reactive protein (hs-CRP) has shown promise as a biomarker to differentiate hepatic nuclear factor 1 alpha (HNF1A)-MODY from type 2 diabetes. We aimed to compare the use of hs-CRP as a biomarker versus traditional criteria, to guide testing for HNF1A-MODY among a cohort of young adults with diabetes in Singapore. A total of 252 adults (age of onset ⩽45 years) and 20 children with diabetes were recruited. Using traditional criteria (family history of diabetes and onset of diabetes ⩽25 years) and an hs-CRP cut off of ⩽0.5 mg/l, 125 and 37 adults, respectively, were identified for HNF1A gene testing. All children underwent HNF1A gene testing. Five adults (5/143, 3.5%) with HNF1A-MODY were identified. There were no HNF1A gene mutations among the children. Traditional criteria correctly identified all five HNF1A-MODY individuals (5/125, 4%), while applying an hs-CRP level of ⩽0.5 mg/l selected just 1 of these 5 for HNF1A gene testing (1/37, 2.7%). None of those with a positive GAD antibody or undetectable C-peptide level had HNF1A-MODY. The use of hs-CRP to guide screening for HNF1A-MODY among Asian young adults with diabetes did not improve the diagnostic yield. Applying a combination of age of onset of diabetes under 25 years and a family history of diabetes alone could guide targeted HNF1A-MODY screening in Asians, with an expected yield of 4% diagnosed with HNF1A-MODY among those screened.

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