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HDL cholesterol as a diagnostic tool for clinical differentiation of
Clinical Endocrinology, 08/30/2011
Fendler W et al. - HDL cholesterol levels measured in individuals with likely monogenic diabetes may be useful in screening for monogenic diabetes caused by glucokinase mutations (GCK-MODY) and differentiation from T1DM and HNF1A-MODY, regardless of treatment or metabolic control.
Methods- The study evaluated the utility of lipid parameters in screening for patients with GCK-MODY.
- Eighty-nine children with type 1 diabetes and 68 with GCK-MODY were screened for triglyceride (TG), total and HDL cholesterol levels.
- Standardization against a control group of 171 healthy children was applied to eliminate the effect of development.
- Clinical applicability and cut-off value were evaluated in all available patients with GCK-MODY (n = 148), hepatocyte nuclear factor 1-alpha-MODY (HNF1A MODY) (n = 37) or type 1 diabetes (n = 221).
- Lower lipid parameter values were observed in GCK-MODY than in patients with type 1 diabetes.
- Standard deviation scores were -0.22 ± 2.24 vs 1•31 ± 2.17 for HDL cholesterol (P < 0.001), -0.16 ± 2.14 vs 0.60 ± 1.77 for total cholesterol (P = 0.03) and -0.57 ± 0.97 vs-0.22 ± 0.97 for TG (P = 0.05).
- Validation analysis confirmed that HDL cholesterol was the best parameter for GCK-MODY selection [sensitivity 87%, specificity 54%, negative predictive value (NPV) 86%, positive PV 56%].
- A threshold HDL concentration of 1.56 m
m offered significantly better diagnostic efficiency than total cholesterol (cut-off value 4.51 mm ; NPV 80%; PPV 38%; P < 0.001). - TG did not offer a meaningful cut-off value.
