Victoria L Rudland1, Marcus Hinchcliffe2, Jason Pinner2, Stuart Cole3, Belinda Mercorella3, Lynda Molyneaux4, Maria Constantino5, Dennis K Yue5, Glynis P Ross5, Jencia Wong5. 1. Discipline of Medicine, The University of Sydney, Sydney, Australia Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia vrudland@med.usyd.edu.au. 2. Discipline of Medicine, The University of Sydney, Sydney, Australia Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, Australia. 3. Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, Australia. 4. Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia. 5. Discipline of Medicine, The University of Sydney, Sydney, Australia Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
Abstract
OBJECTIVE: Glucokinase monogenic diabetes (GCK-maturity-onset diabetes of the young [MODY]) should be differentiated from gestational diabetes mellitus (GDM) because management differs. New pregnancy-specific screening criteria (NSC) have been proposed to identify women who warrant GCK genetic testing. We tested NSC and HbA1c in a multiethnic GDM cohort and examined projected referrals for GCK testing. RESEARCH DESIGN AND METHODS: Using a GDM database, 63 of 776 women had a postpartum oral glucose tolerance test suggestive of GCK-MODY. Of these 63 women, 31 agreed to undergo GCK testing. NSC accuracy and HbA1c were examined. Projected referrals were calculated by applying the NSC to a larger GDM database (n = 4,415). RESULTS: Four of 31 women were confirmed as having GCK-MODY (prevalence ∼0.5-1/100 with GDM). The NSC identified all Anglo-Celtic women but did not identify one Indian woman. The NSC will refer 6.1% of GDM cases for GCK testing, with more Asian/Indian women referred despite lower disease prevalence. Antepartum HbA1c was not higher in those with GCK-MODY. CONCLUSIONS: The NSC performed well in Anglo-Celtic women. Ethnic-specific criteria should be explored.
OBJECTIVE:Glucokinase monogenic diabetes (GCK-maturity-onset diabetes of the young [MODY]) should be differentiated from gestational diabetes mellitus (GDM) because management differs. New pregnancy-specific screening criteria (NSC) have been proposed to identify women who warrant GCK genetic testing. We tested NSC and HbA1c in a multiethnic GDM cohort and examined projected referrals for GCK testing. RESEARCH DESIGN AND METHODS: Using a GDM database, 63 of 776 women had a postpartum oral glucose tolerance test suggestive of GCK-MODY. Of these 63 women, 31 agreed to undergo GCK testing. NSC accuracy and HbA1c were examined. Projected referrals were calculated by applying the NSC to a larger GDM database (n = 4,415). RESULTS: Four of 31 women were confirmed as having GCK-MODY (prevalence ∼0.5-1/100 with GDM). The NSC identified all Anglo-Celtic women but did not identify one Indian woman. The NSC will refer 6.1% of GDM cases for GCK testing, with more Asian/Indian women referred despite lower disease prevalence. Antepartum HbA1c was not higher in those with GCK-MODY. CONCLUSIONS: The NSC performed well in Anglo-Celtic women. Ethnic-specific criteria should be explored.
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