Authors: Shepherd, Maggie; Hattersley, Andrew T.

Source: Clinical Medicine, Journal of the Royal College of Physicians, Volume 4, Number 2, 1 March 2004 , pp. 144-147(4)

Publisher: Royal College of Physicians

Abstract:

Hepatocyte nuclear factor-1 α (HNF-1 α) maturity onset diabetes of the young (MODY) is the commonest cause of monogenic diabetes but is frequently misdiagnosed as type 1 diabetes. The availability of genetic testing in MODY has improved diagnosis. Sulphonylurea sensitivity in HNF-1 α patients means that those on insulin from diagnosis can transfer to sulphonylureas and may improve glycaemic control. To gain insight into the implications for patients of stopping insulin, in-depth interviews were conducted with eight HNF-1 α patients transferred to sulphonylureas after a median of 20 years on insulin. Thematic content analysis highlighted four key themes:

• fear, anxiety and excitement regarding stopping insulin, particularly among those who had been on insulin for many years or had never omitted insulin in the past

• improved lifestyle and self image accompanied by feelings of relief and 'increased normality'

• reflections on their time on insulin, including feelings of annoyance, particularly when the need for insulin treatment had been questioned at diagnosis

• difficulty 'letting go' of insulin treatment - some patients found it hard to believe that they no longer required injections as this conflicted with messages previously received from healthcare professionals.

Transferring from insulin to sulphonylureas had a positive impact on lifestyle but support was needed for patients to adjust, many having grown up with the belief they would be on insulin for life.

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Keywords: GENETIC TESTING; HEPATOCYTE NUCLEAR; FACTOR-1 ALPHA HNF-1 ALPHA; MATURITY ONSET DIABETES OF; THE YOUNG MODY; SULPHONYLUREA SENSITIVITY

Document Type: Regular paper

Publication date: 2004-03-01

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• Clinical Medicine is published six times a year and circulated to 20,000 Fellows and Members of the Royal College of Physicians. The journal is read by physicians both established and in training in hospitals across the world. It features a wide range of articles including original papers, professional issues, clinical guidance, medical humanities, ethics and clinical governance. The journal publishes the key features from the College lectures and conferences. Each issue has a CME section which reviews the latest advances in a chosen specialty.
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