Interactive case study: MODY – a strong family history of diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at all healthcare professionals in primary and community care who would like to broaden their understanding of diabetes.

These two scenarios review the most common subtypes of maturity-onset diabetes of the young (MODY), signs and symptoms, differential diagnosis and management.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve our knowledge and problem-solving skills in diabetes care by encouraging us to make evidence-based decisions in the context of individual cases.

Readers are invited to respond to the questions by typing in their answers. In this way, we are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, readers will feel more confident and empowered to manage such presentations effectively in the future.

George, a 31-year-old chef, comes to the surgery asking to be tested for diabetes. He reports symptoms of thirst and explains that there is a strong family history of diabetes. His BMI is 25.2 kg/m² and a capillary blood glucose reading is 13.4 mmol/L.
How would you proceed from here?

Nadia, 27 years old, has, amongst a set of otherwise normal routine blood investigations, a mildly elevated fasting blood glucose level, confirmed on repeat testing, and is diagnosed with diabetes. Her BMI is 23.2 kg/m² and her HbA_1c is 49 mmol/mol (6.6%). She has no relevant past medical history and her only medication is the combined contraceptive pill. Her father was diagnosed with type 2 diabetes at the age of 43, and this is controlled by diet.
What type of diabetes might you suspect?

By working through this interactive case study, we will consider the signs, symptoms, differential diagnosis and management of maturity-onset diabetes of the young (MODY).