Combination of type I diabetes mellitus and diabetes associated with GCK gene mutation: features of the clinical course in puberty

Abstract

This article discusses a clinical case of the manifestation of MODY2 diabetes, which complicated the course of type I diabetes mellitus in a patient of puberty. For 9 months, the dynamics of the patient’s condition was monitored, who was on inpatient treatment in the endocrinology department of the State Medical Institution of the Tambov City Hospital for the entire period of observation. The criteria for daily monitoring of the patient’s clinical condition were: blood glucose and glycated hemoglobin, the level of glucosuria, the concentration of ketone bodies in the blood and acetone in the urine. The patient underwent insulin therapy and infusion therapy. Despite the ongoing treatment, including, among other things, the treatment of complications of the underlying disease, by the 6th month the patient’s condition worsened to an extremely severe degree. Additional laboratory and instrumental diagnostic studies were conducted, including a molecular genetic study for diabetes typing, the results of which made it possible to determine the cause of the progressive course of type I diabetes mellitus, which was the clinical manifestation of MODY2 diabetes with the development of insulin tolerance against the background of hormonal adjustment of puberty. The problem of timely and accurate diagnosis, and, accordingly, correct treatment, of type I diabetes mellitus combined with MODY2 diabetes, remains urgent and serious, due to the difficulty of interpreting differential diagnostic criteria with progressive type I diabetes mellitus of childhood and adolescence, which in turn can lead to multiple complications, including fatal exodus.