You can read part I in the previous post. You can also read the complete document, much better explained, here https://care.diabetesjournals.org/content/43/Supplement_1/S14
After this post there'll be a third and last one about this chapter, fully dedicated to gestational diabetes.
Cystic Fibrosis Related Diabetes. Starting at age 10, annual screening with OGTT is recommended. A1c is not a good option. Insulin is the treatment of choice, and screening of Diabetes Complications should be made beginning st 5 years from diagnosis.
Post-transplantation Diabetes. Screening should be initiated only when the patient is on stable drug regime. OGTT is the preferred methode, and immunosuppressive drugs should be used for transplant survival irrespective of diabetes status. Insulin is also the preferred therapy and there are no studies evaluating efficacy and safety of other therapeutic options.
Monogenic Diabetes Syndromes. Mody and neonatal diabetes represent less than five percent of total diabetes cases, but they have unique characteristics and implications that make their recognition important. The most common variants are:
- MODY diabetes syndromes:
- GK (Mody 2): stable, no need fot treatment, no long-term complications, usually detected in 2h OGTT.
- HNF1a (Mody 3): progressive, treated with SU, reduced renal thresold for glycosuria.
- HNF4a (Mody 1): progressive, treated with SU, large birth weight.
- HHF1b Mody: renal cysts and genitourinary abnormalities, gout-hyperuricema.
- Neonatal diabetes syndromes:
- Genes related to beta cell K-ATP channel: KCNJ11 (Kir 6.2 subunit), ABCC8 (SUR1 subunit), the most frequent, can be treated with high doses of SU
- Insulin gene mutations (INS)
- Other: 6Q24, GATA6, EIF2AK3, FOXP3
Neonatal diabetes, unlike type 1 diabetes, is usually already present in the first 6 months of life. In 85% of cases a single gene defect can be identified, which has important terapeutic and genetic counseling implications. Some cases can be transient or recurrent, when 6Q24 genes are involved, or permanent.
Mody type diabetes are currently 13 identified autosomal dominant syndromes affecting genes involved in beta cell function. they should be suspected in atypical forms of diabetes, not fitting in type 1 and 2 types, usually diagnosed in teenagers or young adults, stable throughout years, and with first degree-family members also affected. Correct diagnosis is also important for its therapeutic (particularly in GK defect, treated only in pregnancy) and genetic counseling implication. Referral to a specialized clinic is also recommended.
Pancreatic diabetes. Any disease affecting pancreatic gland (neoplasms, pancreatitis, cystic fibrosis, surgery, trauma, infections) may be associated to diabetes. Typical features are exocrine insufficiency (fecal elastase), absence of autoinmunity and high insulin needs. glucagon secretion is also defective.
