Identifying Glucokinase Monogenic Diabetes in a Multiethnic Gestational Diabetes Mellitus Cohort: New Pregnancy Screening Criteria and Utility of HbA1c

• Published in: Diabetes care Vol. 39; no. 1; pp. 50 - 52
• Main Authors: Rudland, Victoria L, Hinchcliffe, Marcus, Pinner, Jason, Cole, Stuart, Mercorella, Belinda, Molyneaux, Lynda, Constantino, Maria, Yue, Dennis K, Ross, Glynis P, Wong, Jencia
• Format: Journal Article
• Language: English
• Published: United States 01.01.2016
• Subjects: Adult; Asian Continental Ancestry Group; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - ethnology; Diabetes Mellitus, Type 2 - genetics; Diabetes, Gestational - blood; Diabetes, Gestational - diagnosis; Diagnosis, Differential; European Continental Ancestry Group; Female; Glucokinase - genetics; Glucose Tolerance Test; Glycated Hemoglobin A - analysis; Humans; Postpartum Period; Pregnancy; Prevalence
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc15-1001

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. 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). 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. The NSC performed well in Anglo-Celtic women. Ethnic-specific criteria should be explored.