Monogenetic forms of diabetes represent 1% to 5% of all diabetes cases and are caused by mutations in a single gene. These mutations, affecting genes involved in pancreatic β-cell development, function and survival or insulin regulation, may be dominant or recessive, inherited or de novo. Most patients with monogenic diabetes are very commonly misdiagnosed as having type 1 or type 2 diabetes. The abundance of each monogenic form of the disease and the severity of their symptoms depend on the nature of the mutation, the function of the affected gene and, in some cases, the influence of additional genetic or environmental factors that modulate severity and penetrance. In some patients, diabetes is accompanied by other syndromic features such as deafness, blindness, microcephaly, liver and intestinal defects, between others. The age of diabetes onset may also vary from neonatal presentations until early adulthood manifestations. Since the different mutations result in diverse clinical presentations, patients usually need different treatments that range from just diet and exercise, to the requirement of exogenous insulin or other hypoglycaemic drugs e.g. sulfonylureas or glucagon like peptide 1 analogs to control their normoglycemia. As a consequence, awareness and correct diagnosis are crucial for the proper management and treatment of monogenic diabetes patients. In this chapter, we describe mutations causing different monogenic forms of diabetes associated with inadequate pancreas development or impaired β-cell function and survival, and discuss the molecular mechanisms involved in β-cell demise.