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Amaratunga SA, Hussein Tayeb T, Muhamad Sediq RN, Hama Salih FK, Dusatkova P, Wakeling MN, De Franco E, Pruhova S, Lebl J. Paediatric diabetes subtypes in a consanguineous population: a single-centre cohort study from Kurdistan, Iraq. Diabetologia 2024; 67:113-123. [PMID: 37897565 PMCID: PMC10709478 DOI: 10.1007/s00125-023-06030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 10/30/2023]
Abstract
AIMS/HYPOTHESIS Monogenic diabetes is estimated to account for 1-6% of paediatric diabetes cases in primarily non-consanguineous populations, while the incidence and genetic spectrum in consanguineous regions are insufficiently defined. In this single-centre study we aimed to evaluate diabetes subtypes, obtain the consanguinity rate and study the genetic background of individuals with syndromic and neonatal diabetes in a population with a high rate of consanguinity. METHODS Data collection was carried out cross-sectionally in November 2021 at the paediatric diabetic clinic, Dr Jamal Ahmad Rashed Hospital, in Sulaimani, Kurdistan, Iraq. At the time of data collection, 754 individuals with diabetes (381 boys) aged up to 16 years were registered. Relevant participant data was obtained from patient files. Consanguinity status was known in 735 (97.5%) participants. Furthermore, 12 families of children with neonatal diabetes and seven families of children with syndromic diabetes consented to genetic testing by next-generation sequencing. Prioritised variants were evaluated using the American College of Medical Genetics and Genomics guidelines and confirmed by Sanger sequencing. RESULTS A total of 269 of 735 participants (36.5%) with known consanguinity status were offspring of consanguineous families. An overwhelming majority of participants (714/754, 94.7%) had clinically defined type 1 diabetes (35% of them were born to consanguineous parents), whereas only eight (1.1%) had type 2 diabetes (38% consanguineous). Fourteen (1.9%) had neonatal diabetes (50% consanguineous), seven (0.9%) had syndromic diabetes (100% consanguineous) and 11 (1.5%) had clinically defined MODY (18% consanguineous). We found that consanguinity was significantly associated with syndromic diabetes (p=0.0023) but not with any other diabetes subtype. The genetic cause was elucidated in ten of 12 participants with neonatal diabetes who consented to genetic testing (homozygous variants in GLIS3 [sibling pair], PTF1A and ZNF808 and heterozygous variants in ABCC8 and INS) and four of seven participants with syndromic diabetes (homozygous variants in INSR, SLC29A3 and WFS1 [sibling pair]). In addition, a participant referred as syndromic diabetes was diagnosed with mucolipidosis gamma and probably has type 2 diabetes. CONCLUSIONS/INTERPRETATION This unique single-centre study confirms that, even in a highly consanguineous population, clinically defined type 1 diabetes is the prevailing paediatric diabetes subtype. Furthermore, a pathogenic cause of monogenic diabetes was identified in 83% of tested participants with neonatal diabetes and 57% of participants with syndromic diabetes, with most variants being homozygous. Causative genes in our consanguineous participants were markedly different from genes reported from non-consanguineous populations and also from those reported in other consanguineous populations. To correctly diagnose syndromic diabetes in consanguineous populations, it may be necessary to re-evaluate diagnostic criteria and include additional phenotypic features such as short stature and hepatosplenomegaly.
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Affiliation(s)
- Shenali A Amaratunga
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Tara Hussein Tayeb
- Diabetic Clinic, Dr Jamah Ahmad Rashed Hospital, Sulaimani, Kurdistan, Iraq
- Department of Paediatrics, College of Medicine, Sulaimani University, Sulaimani, Kurdistan, Iraq
| | - Rozhan N Muhamad Sediq
- Diabetic Clinic, Dr Jamah Ahmad Rashed Hospital, Sulaimani, Kurdistan, Iraq
- Department of Paediatrics, College of Medicine, Sulaimani University, Sulaimani, Kurdistan, Iraq
| | | | - Petra Dusatkova
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Matthew N Wakeling
- Clinical and Biomedical Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Elisa De Franco
- Clinical and Biomedical Sciences, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
| | - Stepanka Pruhova
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jan Lebl
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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Patel KA, Ozbek MN, Yildiz M, Guran T, Kocyigit C, Acar S, Siklar Z, Atar M, Colclough K, Houghton J, Johnson MB, Ellard S, Flanagan SE, Cizmecioglu F, Berberoglu M, Demir K, Catli G, Bas S, Akcay T, Demirbilek H, Weedon MN, Hattersley AT. Systematic genetic testing for recessively inherited monogenic diabetes: a cross-sectional study in paediatric diabetes clinics. Diabetologia 2022; 65:336-342. [PMID: 34686905 PMCID: PMC8741690 DOI: 10.1007/s00125-021-05597-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022]
Abstract
AIMS/HYPOTHESIS Current clinical guidelines for childhood-onset monogenic diabetes outside infancy are mainly focused on identifying and testing for dominantly inherited, predominantly MODY genes. There are no systematic studies of the recessively inherited causes of monogenic diabetes that are likely to be more common in populations with high rates of consanguinity. We aimed to determine the contribution of recessive causes of monogenic diabetes in paediatric diabetes clinics and to identify clinical criteria by which to select individuals for recessive monogenic diabetes testing. METHODS We conducted a cross-sectional study of 1093 children from seven paediatric diabetes clinics across Turkey (a population with high rates of consanguinity). We undertook genetic testing of 50 known dominant and recessive causes of monogenic diabetes for 236 children at low risk of type 1 diabetes. As a comparison, we used monogenic diabetes cases from UK paediatric diabetes clinics (a population with low rates of consanguinity). RESULTS Thirty-four children in the Turkish cohort had monogenic diabetes, equating to a minimal prevalence of 3.1%, similar to that in the UK cohort (p = 0.40). Forty-one per cent (14/34) had autosomal recessive causes in contrast to 1.6% (2/122) in the UK monogenic diabetes cohort (p < 0.0001). All conventional criteria for identifying monogenic diabetes (parental diabetes, not requiring insulin treatment, HbA1c ≤ 58 mmol/mol [≤7.5%] and a composite clinical probability of MODY >10%) assisted the identification of the dominant (all p ≤ 0.0003) but not recessive cases (all p ≥ 0.2) in Turkey. The presence of certain non-autoimmune extra-pancreatic features greatly assisted the identification of recessive (p < 0.0001, OR 66.9) but not dominant cases. CONCLUSIONS/INTERPRETATION Recessively inherited mutations are a common cause of monogenic diabetes in populations with high rates of consanguinity. Present MODY-focused genetic testing strategies do not identify affected individuals. To detect all cases of monogenic paediatric diabetes, it is crucial that recessive genes are included in genetic panels and that children are selected for testing if they have certain non-autoimmune extra-pancreatic features in addition to current criteria.
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Affiliation(s)
- Kashyap A Patel
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK.
| | - Mehmet N Ozbek
- Department of Paediatric Endocrinology, Gazi Yasargil Diyarbakir Training and Research Hospital, Diyarbakir, Turkey
| | - Melek Yildiz
- Department of Paediatric Endocrinology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
- Department of Paediatric Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tulay Guran
- Department of Paediatric Endocrinology and Diabetes, Marmara University Hospital, Istanbul, Turkey
| | - Cemil Kocyigit
- Department of Paediatric Endocrinology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sezer Acar
- Department of Paediatric Endocrinology, Dokuz Eylul University, Izmir, Turkey
- Division of Paediatric Endocrinology, Dr Behcet Uz Child Disease and Paediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Zeynep Siklar
- Department of Paediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Muge Atar
- Department of Paediatric Endocrinology, Kocaeil University Hospital, Izmit, Turkey
- Department of Paediatric Endocrinology, Suleyman Demirel University, Isparta, Turkey
| | - Kevin Colclough
- Department of Molecular Genetics, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, UK
| | - Jayne Houghton
- Department of Molecular Genetics, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, UK
| | - Matthew B Johnson
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
- Department of Molecular Genetics, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, UK
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Filiz Cizmecioglu
- Department of Paediatric Endocrinology, Kocaeil University Hospital, Izmit, Turkey
| | - Merih Berberoglu
- Department of Paediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey
| | - Korcan Demir
- Department of Paediatric Endocrinology, Dokuz Eylul University, Izmir, Turkey
| | - Gonul Catli
- Department of Paediatric Endocrinology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Serpil Bas
- Department of Paediatric Endocrinology and Diabetes, Marmara University Hospital, Istanbul, Turkey
| | - Teoman Akcay
- Department of Paediatric Endocrinology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
- Department of Paediatric Endocrinology, Istinye University, Gaziosmanpasa Medical Park Hospital, Istanbul, Turkey
| | - Huseyin Demirbilek
- Department of Paediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Michael N Weedon
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, UK
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Abstract
PURPOSE OF REVIEW We provide a review of monogenic diabetes in young children and adolescents with a focus on recognition, management, and pharmacological treatment. RECENT FINDINGS Monogenic forms of diabetes account for approximately 1-2% of diabetes in children and adolescents, and its incidence has increased in recent years due to greater awareness and wider availability of genetic testing. Monogenic diabetes is due to single gene defects that primarily affect beta cell function with more than 30 different genes reported. Children with antibody-negative, C-peptide-positive diabetes should be evaluated and genetically tested for monogenic diabetes. Accurate genetic diagnosis impacts treatment in the most common types of monogenic diabetes, including the use of sulfonylureas in place of insulin or other glucose-lowering agents or discontinuing pharmacologic treatment altogether. Diagnosis of monogenic diabetes can significantly improve patient care by enabling prediction of the disease course and guiding appropriate management and treatment.
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Affiliation(s)
- May Sanyoura
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA
| | - Louis H Philipson
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA
| | - Rochelle Naylor
- Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, The University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA.
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Abstract
Diabetes mellitus is a heterogeneous group of conditions defined by resultant chronic hyperglycemia. Given the increasing prevalence of diabetes mellitus and the increasing understanding of genetic etiologies, we present a broad review of rare genetic forms of diabetes that have differing diagnostic and/or treatment implications from type 1 and type 2 diabetes. Advances in understanding the genotype-phenotype associations in these rare forms of diabetes offer clinically available examples of evolving precision medicine where defining the correct genetic etiology can radically alter treatment approaches. In this review, we focus on forms of monogenic diabetes, mitochondrial diabetes, and syndromic diabetes.
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Affiliation(s)
- Roseanne O Yeung
- Division of Endocrinology and Metabolism, University of Alberta, 9114- Clinical Sciences Building, 11350-83 Avenue, Edmonton, AB, T6G 2G3, Canada.
| | - Fady Hannah-Shmouni
- Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Karen Niederhoffer
- Department of Medical Genetics, University of Alberta, 8-53 Medical Sciences Building, Edmonton, AB, T6G 2H7, Canada
| | - Mark A Walker
- Institute of Cellular Medicine (Diabetes), The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
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