The 0.1% of the population with glucokinase monogenic diabetes can be recognized by clinical characteristics in pregnancy: the atlantic diabetes in pregnancy cohort
Chakera, Ali J. Spyer, Gill Vincent, Nicola Ellard, Sian Hattersley, Andrew T. Dunne, Fidelma P.
Chakera, Ali J.
Spyer, Gill
Vincent, Nicola
Ellard, Sian
Hattersley, Andrew T.
Dunne, Fidelma P.
Publication Date
2014-02-18
Type
Article
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Chakera, Ali J. Spyer, Gill; Vincent, Nicola; Ellard, Sian; Hattersley, Andrew T.; Dunne, Fidelma P. (2014). The 0.1% of the population with glucokinase monogenic diabetes can be recognized by clinical characteristics in pregnancy: the atlantic diabetes in pregnancy cohort. Diabetes Care 37 (5), 1230-1236
Abstract
OBJECTIVEIdentifying glucokinase monogenic diabetes (GCK-MODY) in pregnancy is important, as management is different from management for other forms of gestational diabetes mellitus (GDM) and there is no increased maternal risk of type 2 diabetes. We calculated the population prevalence of GCK-MODY in pregnancy and determined the clinical characteristics that differentiate pregnant women with GCK-MODY from those with GDM.RESEARCH DESIGN AND METHODSWe calculated the population prevalence of GCK-MODY in pregnancy by testing a subset of patients from the population-based Atlantic Diabetes in Pregnancy (Atlantic DIP) study (n = 5,500). We sequenced for GCK mutations in 247 women with a fasting glucose 5.1 mmol/L and 109 randomly selected control subjects with normal fasting glucose. Using data from the cases found and 40 previously identified GCK-MODY pregnancies, we analyzed whether clinical criteria could be used to differentiate GCK-MODY from GDM.RESULTSFour women with fasting glucose 5.1 mmol/L were diagnosed with GCK-MODY. No cases were identified with normal fasting glucose. The population prevalence of GCK-MODY is 1.1 in 1,000 (95% CI 0.3-2.9 in 1,000) and prevalence in GDM is 0.9% (95% CI 0.3-2.3). Fasting glucose and BMI significantly differentiate GCK-MODY from GDM (P < 0.0001). Combined criteria of BMI <25 kg/m(2) and fasting glucose 5.5 mmol/L has a sensitivity 68%, specificity 96%, and number needed to test of 2.7 women with GDM to find one case of GCK-MODY.CONCLUSIONSOur large population cohort of pregnant women tested estimates the population prevalence of GCK-MODY of 1.1 in 1,000. We have shown routine clinical criteria that can identify which women should be tested for GCK-MODY in pregnancy.
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Publisher
American Diabetes Association
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Attribution-NonCommercial-NoDerivs 3.0 Ireland