ISSN No. 1606-7754                   Vol.15 No.2  August 2007

Non-ketotic diabetes in Saudi Arabian youths: MODY or early onset of type 2 diabetes?
Emmanuel Udezue and Fatma Mohamed
Young Diabetic Clinic, Internal Medicine Services, Saudi Aramco Al Hasa Health Center, Saudi Arabia

Abstract

Background: Non-ketotic diabetes mellitus is commonly seen in young Saudi Arabian adults. This could be either early onset of typical type 2 diabetes, T2DM or maturity-onset diabetes of the young, MODY. Consanguinity is also prevalent and clouds the inheritance pattern of the disease. Distinction between the two on clinical grounds alone is not always possible. Materials and Method: Diabetic patients aged  25 years with family history of the disease who had maintained reasonable glycaemic control with diet and/or oral hypoglycaemic agents for at least two years were studied. Demographic data, presentation details and clinical course were analyzed for classification of patients as possible cases of MODY, using generally accepted criteria. Results: Twenty three patients with diabetes through three consecutive generations were identified as possible cases of MODY from a clinic population of about 200. However, they could also have been early onset cases of T2DM, and differentiation between the two could not be made with certainty without further tests. Conclusion: More studies including genetic testing would be needed to differentiate between early onset T2DM and MODY, according to the current WHO classification. Since most developing countries among which the increasing burden of DM lies cannot do this, there is a need to review the current classification of diabetes. (Int J Diabetes Metab 15:59-60, 2007)

Keywords: Diabetes classification, Type2 diabetes, MODY, consanguinity.Introduction

Introduction

Maturity onset diabetes of the young, MODY, previously classified with type 2 diabetes, T2DM, is now part of type 3 diabetes according to the current World Health Organization (WHO) classification of diabetes.1 Ketosis-resistance and non-insulin dependence which are key MODY features, are also typical of T2DM.2 Such non-ketotic diabetes (NKDM) is common among youths in Eastern Saudi Arabia where consanguinity is common. Distinguishing clinically between MODY and T2DM can be difficult.

Table 1: Patients clinical profile

Characteristic Prevalence (% of patients)
Obesity/overweight 60
Related parents 70
C-peptide 80 % normal values
Insulin need (2 years after diagnosis) 14
M/F ratio 19/4 = 5/1
Mean HBA1c <8% on diet/OHA 85%
Ketosis resistance  
Mean PPG (mmol/l) 21.3 (normal range 3.3-6.1)
Mean HCO3 (mmol/l) 24 (normal range 24-32)
DKA occurrence 0

DKA = Diabetic keto-acidosis
PPG= Presenting plasma glucose
HCO3= Serum bicarbonate

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