WYTYCZNE DOTYCZĄCE DIAGNOSTYKI I LECZENIA CUKRZYC MONOGENOWYCH U DZIECI - REKOMENDACJE ISPAD 2009 A PRAKTYKA KLIN ICZNA.

Monogenic diabetes are a heterogenic group of diseases with varied phenotypes. It is assumed that they may total up to 10% of all cases of diabetes. Diagnosis of these clinical conditions by an efficient selection of patients for genetic diagnostics may be problematic even for experienced diabetologists. Helpful information about selecting and directing patients for further examinations can be gained from guidelines created by diabetologic societies such as International Society of Pediatric and Adolescent Diabetes (ISPAD). This paper focuses on key aspects of these guidelines and elucidates crucial features of the clinical picture which can be used for differential diagnosis of diabetes. Among factors suggesting monogenic background of diabetes the most notable are: low daily insulin requirement (<0.5 U/kg), moderate hyperglycemia (5.5-8.5 mmol/l), positive familial history with a dominant pattern of inheritance, lack of immunologic markers typical for type I diabetes and presence of structural or functional abnormalities within other organs and systems. ISPAD guidelines however, are burdened by some inconsistencies, reflecting different screening and investigative approaches used by various authors. These incongruities have been resolved by the authors of this paper with added suggestions of how to implement relevant solutions in clinical practice. In this article current guidelines on the treatment of monogenic diabetes in children were also presented. Current therapeutic standards were taken into consideration as well as prospects for treatment of selected forms of monogenic diabetes. It will enable in the near future effective and causal treatment of genetic forms of diabetes in children. [ABSTRACT FROM AUTHOR]