One form of maturity-onset diabetes of the young, Type 3 (MODY3), results from mutations in the gene coding for hepatocyte nuclear factor-1␣ (HNF-1␣), a transcription factor first described in the liver. MODY3 is characterized by a defective glucosestimulated insulin secretion. Earlier observations of glycosuria with normal blood glucose levels in some MODY families suggest an additional renal manifestation of the respective genetic defect.
We measured the renal threshold for glucose in five diabetic carriers of a missense mutation (Arg 272 His) in HNF-1␣ and, for comparison, in eight Type 1 diabetic patients, applying a non-invasive protocol of frequent parallel blood and urine sampling during a slow shift in blood glucose levels.
We found that the mean renal threshold for glucose was lowered in the HNF-1␣ diabetic patients compared to those with Type 1 diabetes (6.5 ؎ 0.9 mmol l ؊1 vs 10.7 ؎ 0.5 mmol l ؊1 ; p Ͻ 0.01). This lowered glucose threshold might be an indication of an extra-pancreatic effect of HNF-1␣ gene mutations in humans. Defects in HNF-1␣ may lead to an altered tubular glucose reabsorption, possibly due to decreased expression of the renal glucose transporter proteins involved in reabsorption of glucose from the urine.