Prevalence and progression of diabetes in mitochondrial disease

• Published in: Diabetologia Vol. 50; no. 10; pp. 2085 - 2089
• Main Authors: Whittaker, R. G, Schaefer, A. M, McFarland, R, Taylor, R. W, Walker, M, Turnbull, D. M
• Format: Journal Article
• Language: English
• Published: Berlin Berlin/Heidelberg : Springer-Verlag 01-10-2007; Springer; Springer Nature B.V
• Subjects: Biological and medical sciences; Diabetes; Diabetes Complications - epidemiology; Diabetes Complications - genetics; Diabetes. Impaired glucose tolerance; Disease Progression; DNA, Mitochondrial - genetics; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Errors of metabolism; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Genetic testing; genotype; Genotype & phenotype; Heteroplasmy; Histology; Humans; Insulin; Longitudinal studies; Medical sciences; Metabolic diseases; Miscellaneous hereditary metabolic disorders; mitochondria; Mitochondrial Diseases - epidemiology; Mitochondrial Diseases - genetics; Mitochondrial Diseases - physiopathology; Mitochondrial DNA; Mutation; Neurosciences; Polymorphism, Single Nucleotide; Prevalence; Progression; Urine; United Kingdom > UK; Endocrinopathy; Progression; Mutations; Prevalence; Diabetes mellitus; Metabolic diseases; Genotype; Enzymopathy; Mitochondrial disorder; Genetic disease; Mitochondria; Heteroplasmy; Mutation; Diabetes
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-007-0779-9

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.