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Lisa Letourneau Part 6, Sulfonylureas, Diet, and Exercise

In part 6, the conclusion of this Exclusive Interview, Lisa Letourneau talks with Diabetes in Control Publisher Steve Freed about the effectiveness of various diabetes treatments lifestyle modifications and sulfonylureas for monogenic diabetes, and how to get further information.

Lisa Letourneau MPH, RD, LDN, is a dietitian and diabetes & genetics clinical research manager at the University of Chicago.

Transcript of this video segment:

Freed: One of the things that I know about monogenic diabetes is that many times it can be treated with sulfonylurea, as you mentioned, which is a very inexpensive drug compared to what’s out there today. What percentage of patients did you see could be treated with sulfonylurea?

Letourneau: So, for the neonatal patients, people with KCNJ11 or ABCC8 mutations are responsive to sulfonylurea at pretty high doses which is sometimes surprising for health care professionals, even up to two milligrams per kilo of sulfonylurea for patients. So, they tend to be pretty responsive. For the MODY side of things, HNF1alpha patients are pretty sulfonylurea sensitive where they might only need a quarter of a tablet a day. And HNF4alpha patients can be sulfonylurea sensitive but usually not quite as much as HNF1alpha. And HNF1alpha mutations are the second most common cause of monogenic diabetes in our registry in the US, whereas in Europe they’re actually the most common cause. So, it’s a fair number of patients from our registry that use sulfonylureas instead of insulin or other medications.

Freed: Do patients that have monogenic diabetes react to nutrition and physical activity as other type 1s and type 2s? It’s so important for people with 1 or 2 type diabetes. How important is that for the monogenic patient?

Letourneau: Yeah. It’s still important. I think as we deal with patients with monogenic diabetes, the genetic testing and as you mentioned the medication really usually takes the forefront, but just like type 1 and type 2 nutrition and exercise can certainly help with control of high blood sugars. We’re not so sure about how much diet modification, how much of an impact that might have for people that have GCK-MODY. As I mentioned before they have these pretty stable mildly elevated fasting blood sugars and we don’t think that being on a very low carb diet would modify their blood sugars enough for it to be clinically meaningful. But to investigate that thoroughly they’re already actually starting a study on that at the moment, so we’ll have more information about that hopefully soon.

Freed: Well, in the end of the conversation, I know that nowadays if you want information, go to the internet.

Letourneau: Yes.

Freed: So, I’m sure you have a website developed —

Letourneau: We do.

Freed: — an educational website. And where would people go?

Letourneau: Yeah. So, it’s www.monogenicdiabetes.org. There’s lots of information on there for health care professionals as well as for patients. And if patients are interested in signing up for our registry, there is a link to our registration form there as well.

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