[2]. HEX functions from very early in embryogenesis (E4.5) through adulthood and is involved in the regulation of genes at multiple developmental states, including mature tissue and cell type [3]. HHEX is expressed before the gene encoding the key pancreatic transcription factor, pancreatic and duodenal homeobox protein 1 (PDX1), and mouse embryos lacking HHEX do not express PDX1 in the ventral pancreas, whereas expression in the dorsal pancreas is unaffected [1]. HEX has also been shown to activate hepatocyte nuclear factor 1α (HNF1α), an important transcription factor not only in beta cell development but also in the regulation of insulin secretion [4].Mutations in key transcription factors for pancreatic development are responsible for monogenic forms of beta cell dysfunction, resulting in both hyper-and hypoglycaemia [5,6]. Homozygous or compound heterozygous mutations in PDX1 cause permanent neonatal diabetes (PNDM) with pancreatic agenesis [5], whilst heterozygous mutations result in MODY [5]. Mutations in the genes Diabetologia