Prevalence and progression of diabetes in mitochondrial disease |
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Authors: | R G Whittaker A M Schaefer R McFarland R W Taylor M Walker D M Turnbull |
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Institution: | (1) Mitochondrial Research Group, School of Neurology, Neurobiology and Psychiatry, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK;(2) Diabetes Research Group, School of Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK |
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Abstract: | Aims/Hypothesis The aims of this study were (1) to determine the prevalence and rate of progression in diabetes secondary to mitochondrial
DNA (mtDNA) mutations; and (2) to determine whether percentage heteroplasmy predicts clinical outcome in patients carrying
the m.3243A>G mutation.
Methods We prospectively assessed 242 patients attending a specialist neuromuscular clinic using a validated mitochondrial disease
rating scale. Retrospective clinical data on these patients from up to 25 years of follow-up were also included. Percentage
heteroplasmy in blood, urine and muscle was determined for the m.3243A>G group and correlated against clinical features.
Results Patients carrying the m.3243A>G mutation formed the largest group of patients with diabetes (31/81 patients). The highest
prevalence of diabetes was in the m.12258C>A group (2/2 patients), the lowest in the multiple mtDNA deletions group (3/43
patients). The earliest age of onset was in the m.3243A>G group (37.9 years) with the highest age of presentation in the multiple
deletion group (56.3 years). Of patients presenting with m.3243A>G, 12.9% required insulin; an additional 32.3% progressed
to insulin requirement over a mean of 4.2 years after presentation. Percentage heteroplasmy in blood, urine or muscle did
not predict progression of diabetes or risk of developing complications. Early age of presentation with diabetes did predict
poor clinical outcome.
Conclusions/Interpretation Although patients carrying the m.3243A>G mutation account for the majority of cases of diabetes secondary to mtDNA mutations,
several other genotypes are also associated with the development of diabetes, some with high penetrance. All show a gradual
progression to insulin requirement. Percentage heteroplasmy is a poor predictor of severity of diabetes in the m.3243A>G group. |
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Keywords: | Diabetes Genotype Heteroplasmy Mitochondria Mutations Prevalence Progression |
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