Sulphonylureas and DPP4 Inhibitors: Similar Efficacy in MODY 3 Patients?

Presentation Number: SAT-774
Date of Presentation: June 15th, 2013

César Esteves1, Eva Lau2, Celestino Neves*3, Paula Freitas2 and Davide Carvalho1
1Centro Hospitalar São João, Faculty of Medicine, University of Porto, Portugal, 2Centro Hospitalar São João; Faculty of Medicine, Porto University, Portugal, 3Centro Hospitalar São João, Rio Tinto NA, Portugal

Abstract

Introduction: Maturity Onset Diabetes of the Young (MODY) type 3 results from mutations of the HNF1α gene, resulting in abnormal insulin secretion. According to the degree of hyperglycaemia it can be managed with oral hypoglycemic agents or insulin. Currently, there is no consensus regarding the best therapeutic strategy for these patients. Case report: We report 3 cases of MODY type 3: 1) Female, 18 years old, diagnosis of diabetes mellitus (DM) at 15 years old, without evidence of autoimmunity; she had a family history of DM diagnosed in the third decade of life for at least three generations of the paternal lineage. After confirmation of MODY3 by genetic test, insulin therapy was discontinued and glyburide 2.5 mg od was initiated. Due to recurrent hypoglycemia, she is currently medicated with glyburide 1.25 mg od, with a good metabolic control. 2) Male, history of DM since 34 years old, medicated with glyburide 2.5 mg bid (HbA1c 6.5%). His father, 5 of 7 brothers and 2 nephews had DM, diagnosed between the ages of 16 and 38. Genetic test confirmed MODY type 3. 3) Male, 37 years old, diagnosis of DM at age of 27, without evidence of auto-immunity. Current HbA1c of 6.2%  under vildagliptin/metformin 50/1000mg bid. He had a family history of DM: father and paternal grandfather, diagnosed in adulthood. Genetic study confirmed MODY3. Conclusion: These cases highlight different successful approaches in managing MODY3. The hypoglycaemic effects of sulfonylureas in these patients are well documented, but dipeptylpeptidase-4-inhibitors seem to be a good alternative, without the risk of hypoglycaemia.

 

Nothing to Disclose: CE, EL, CN, PF, DC