Do Bangladeshi youth-onset diabetes patients need genetic screening for MODY?

*Corresponding and presenting author:

Mashfiqul-Hasan, PhD student, Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Cell no: +8801816268746; E-mail: mashfiqul.phd.m22@bsmmu.edu.bd

ABSTRACT:

Background: Identifying maturity-onset diabetes in young (MODY) is rarely diagnosed and the majority are managed as type-1 or type-2 diabetes.  Application of the MODY probability calculator (a web-based tool devised by the University of Exeter, UK) may identify those who have a likelihood of MODY and need genetic screening.

Objectives: To estimate the probability of MODY in Bangladeshi newly diagnosed youth-onset diabetes patients by applying the MODY probability calculator.

Methods: This cross-sectional study enrolled 84 newly-diagnosed youth-onset diabetes [age 13-29 years, female 49 (58.4%), none had ketosis at diagnosis] during March-December 2022 in the Endocrinology department, BSMMU. Of them, 6 were excluded [positive islet-autoantibody (GAD-65, ZnT8 and/or IA2 antibody) in 4, C-peptide <0.5 ng/mL in 1, pancreatic calcification in 1].  MODY probability was calculated by the MODY probability calculator (available on www.diabetesgenes.org) which uses a weighted combination of the patient’s current age, age at diagnosis, sex, parental family history of diabetes, BMI, HbA1c, ongoing treatment and need for insulin therapy. Persons with a MODY probability ≥60% are considered to have a high probability and are recommended for genetic testing.

Results:  Among the participants, 30.8% (24 of 78) had a high probability of MODY. The high-probability group had lower age (20.3±5.8 vs 26.3±3.4 years, p<0.001), lower HbA1c (7.3±1.2 vs 10.0±3.1%, p<0.001), a trend of higher frequency of parental diabetes history (75.0% vs 51.9%, p=0.055); but BMI (26.8±4.7 vs 26.0±5.2 kg/m², p=0.547), C-peptide [5.2 (3.8-7.8) vs 4.1 (3.0-6.4) ng/mL, p=0.120] and HOMA-IR [1.8 (1.7-2.0) vs 1.8 (1.7-1.9), p=0.101)] were statistically similar to the low-probability group. None of the high-probability group needed insulin while 29.6% of the low-probability group needed it.

Conclusion: Nearly one in three youth-onset apparently type-2 diabetes patients have a high probability of MODY and hence require genetic screening.

Keywords: MODY, diabetes in young, Bangladeshi, MODY probability calculator