Njølstad Pål R, Hertel Jens K, Søvik Oddmund, Raeder Helge, Johansson Stefan, Molven Anders
Senter for diabetesgenetikk, Barneklinikken, Haukeland universitetssykehus, 5021 Bergen, Norway.
Tidsskr Nor Laegeforen. 2010 Jun 3;130(11):1145-9. doi: 10.4045/tidsskr.09.1035.
Diabetes is classified as Type 1 diabetes, Type 2 diabetes, gestational diabetes and other types. Our goal was to provide an overview of new genetic knowledge of monogenic and type 2 diabetes.
The article is based on literature identified through a non-systematic search in PubMed and own experience concerning research in diabetes genetics and treatment of patients with monogenic diabetes.
18 genes have been found for which one single mutation may cause diabetes. The most common causes for such monogenic diabetes are mutations in the genes KCNJ11, ABCC8 and INS when the condition is diagnosed at the age 0 - 6 months, and in the genes HNF1A, GCK, HNF4A and HNF1B when the diagnosis is made later than six months of age. Genetic testing is appropriate in assessment of monogenic diabetes, because antidiabetic tablets rather that insulin injections can be used to treat patients with mutations in certain genes; i.e. KCNJ11, ABCC8, HNF1A and HNF4A. Genome-wide association studies have recently identified about 20 genetic variants that increase the risk of Type 2 diabetes, but which have a low predictive value for development of disease. How these genetic variants can cause Type 2 diabetes has not been assessed and clinical relevance remains to be shown.
So far, genetic findings only affect diagnosis and treatment of monogenic diabetes.
糖尿病分为1型糖尿病、2型糖尿病、妊娠期糖尿病和其他类型。我们的目标是概述单基因糖尿病和2型糖尿病的新遗传学知识。
本文基于通过在PubMed中进行非系统检索所确定的文献以及我们自身在糖尿病遗传学研究和单基因糖尿病患者治疗方面的经验。
已发现18个基因,单个突变可能导致糖尿病。对于此类单基因糖尿病,最常见的病因是在0至6个月龄诊断时,基因KCNJ11、ABCC8和INS发生突变;而在6个月龄之后诊断时,基因HNF1A、GCK、HNF4A和HNF1B发生突变。基因检测适用于单基因糖尿病的评估,因为对于某些基因突变的患者(即KCNJ11、ABCC8、HNF1A和HNF4A基因突变患者),可以使用抗糖尿病片剂而非胰岛素注射进行治疗。全基因组关联研究最近已鉴定出约20种增加2型糖尿病风险的基因变异,但这些变异对疾病发生的预测价值较低。这些基因变异如何导致2型糖尿病尚未得到评估,其临床相关性仍有待证明。
到目前为止,遗传学研究结果仅影响单基因糖尿病的诊断和治疗。