Background
Given the increasing evidence supporting the association between telomere shortening and diabetes, the aim of the present work was to establish whether MODY patients suffer a reduction in telomere lenght (TL) due to oxidative stress produced by chronic hyperglycemia, despite not presenting insulin resistance or inflammation.
Methods
We analysed clinical and biochemical parameters in 35 MODY2 and 12 MODY3 patients compared with 48 control subjects. The absolute telomere length (aTL) of peripheral blood leukocytes was measured using the quantitative polymerase chain reaction (qPCR).
Results
A significant negative correlation was observed between aTL and age in the whole population, among MODY patients and in each subtype studied, MODY2 and MODY3, which allowed us to validate the method. We found, for the first time, that MODY patients have shorter aTL with respect to non‐diabetic controls (6.49 ± 3.31 kbp vs 11.13 ± 7.82 kbp, p = .006). However, no differences were found between MODY2 and MODY3. In addition, aTL showed a negative correlation with duration of the disease and fasting plasma glucose (FPG) levels in MODY patients in general and also with HbA1c in MODY2 patients in particular.
Conclusions
Both MODY2 and MODY3 types present telomere shortening, which, at least partly, responds to HbA1c and FPG levels. These findings suggest comparable mechanisms underlying the attrition of TL. Taken together, our results on aTL in MODY patients may provide a parameter relatively easy and inexpensive to quantify in order to measure the impact of high glucose levels and potentially carry out antidiabetic treatment with stricter targets.
El término MODY (Maturity Onset Diabetes in Youngs) proviene de la antigua clasificación de la DM que la subdividía en aquellas que comenzaban en la juventud de las que lo hacían en la edad adulta. En la actualidad, se las encuadra dentro de aquellos cuadros caracterizados por “defectos genéticos en la función de la célula beta”. Es una forma monogénica de la enfermedad cuyo denominador común es la hiposecreción de insulina como factor desencadenante primario. Actualmente se han identificado 13 subtipos de MODY. Si bien MODY representa aproximadamente el 1-2% de los pacientes con DM, se estima que un gran porcentaje de los casos se encuentra sin diagnosticar. En cuanto a la frecuencia relativa, MODY 2 y MODY 3 representan alrededor del 60-80% de los casos, y MODY 1 el 10% de los mismos. En general, los pacientes con MODY se caracterizan por tener: 1) DM de comienzo en la edad joven, en general menores de 25 años; 2) fuerte influencia familiar; 3) sin estigmas de insulinorresistencia; 4) insulinoindependencia; 5) ausencia de autoanticuerpos relacionados con DM autoinmune. El diagnóstico de MODY trae aparejada implicancias pronósticas, terapéuticas y sobre consejo genético. Aquellos pacientes con mutación en glucoquinasa (MODY 2) habitualmente no desarrollan complicaciones crónicas tanto micro como macrovasculares y en general no requieren tratamiento farmacológico, mientras que aquellos con mutaciones en HNF-1α (MODY 3) tienen tendencia a complicaciones microvasculares y poseen la característica de presentar hiperrespuesta a dosis bajas de sulfonilureas, incluso en algunas ocasiones presentan hipoglucemias severas.
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