DOI: 10.12890/2025_005892

Gliclazide challenge testing as an alternative diagnostic tool for hepatocyte nuclear factor-1-alpha maturity onset diabetes of the young

Authors

  • Sunjay Pandya Department of Endocrinology and Diabetes, George Eliot Hospital NHS Trust, Nuneaton, UK
  • Rutbah Khairati Department of Medicine, George Eliot Hospital NHS Trust, Nuneaton, UK
  • Jesheen Mann Department of Medicine, George Eliot Hospital NHS Trust, Nuneaton, UK
  • Lucy Archer Department of Endocrinology and Diabetes, George Eliot Hospital NHS Trust, Nuneaton, UK
  • Ponnusamy Saravanan Department of Endocrinology and Diabetes, George Eliot Hospital NHS Trust, Nuneaton, UK; Warwick Medical School, University of Warwick, Coventry, UK
  • Fernando Erneta III Department of Endocrinology and Diabetes, George Eliot Hospital NHS Trust, Nuneaton, UK
  • Vinod Patel Department of Endocrinology and Diabetes, George Eliot Hospital NHS Trust, Nuneaton, UK; Warwick Medical School, University of Warwick, Coventry, UK

Jesheen.Mann2@geh.nhs.uk

Keywords

Maturity-onset diabetes of the young (MODY), monogenic diabetes, HNF1A mutation, gliclazide, C-peptide

Abstract

Background: Hepatocyte nuclear factor-1-alpha monogenic diabetes (HNF1-alpha DM), formerly known as maturity-onset diabetes of the young type 3 (MODY 3), is often misdiagnosed as type 1 or type 2 diabetes. In regions where genetic testing is unavailable, alternative diagnostic approaches are needed.
Case report: A 20-year-old woman was initially diagnosed with type 1 diabetes after an incidental finding of hyperglycaemia. Despite adherence to treatment, she experienced recurrent hypoglycaemia on basal-bolus insulin, receiving over 2600 injections in 8 years. Autoantibodies were negative, C-peptide levels were preserved, and her estimated probability of MODY exceeded 10%. While awaiting genetic testing, she underwent a “glicazide challenge test”, which showed a marked stimulatory response in blood glucose and C-peptide levels. Subsequent testing confirmed HNF1-alpha MODY. Insulin was stopped, and she was started on low dose gliclazide, achieving excellent control with minimal hypoglycaemia.
Conclusion: This case demonstrates the gliclazide challenge test’s potential as an alternative diagnostic and therapeutic tool in suspected maturity-onset diabetes of the young when genetic testing is limited.

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References

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Published

2025-12-04

Issue

Vol. 12 No. 12 (2025)

Categories

How to Cite

1.
Pandya S, Khairati R, Mann J, Archer L, Saravanan P, Erneta III F, et al. Gliclazide challenge testing as an alternative diagnostic tool for hepatocyte nuclear factor-1-alpha maturity onset diabetes of the young. EJCRIM [Internet]. 2025 Dec. 4 [cited 2026 Nov. 3];12(12). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5892