What is it about?
HNF4A-MODY (MODY1) has historically been treated with Sulfonylureas, these medications can cause low blood sugars and difficulty for people that need to drive or operate heavy machinery. We trialled an existing therapy for other types of diabetes and found it to work in this genetic type of diabetes.
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Why is it important?
Why did we undertake this study? - HNF1A-MODY has seen an evidence base for first line treatment with SGLT2i therapy but no such case reports exist for HNF4A-MODY. We wanted to answer "Is it possible to use novel therapies to spare the use of Sulfonylurea or Insulin in HNF4A-MODY similar to HNF1A-MODY" What did we find? - SGLT2i therapy usage was associated with an improvement in Hba1c to 46mmol/mol (6.3%) which was an improvement upon our patient’s Sulfonylurea/Insulin therapy with no adverse incidents. SGLT2i may yet be considered as Sulfonylurea sparing agents in HNF4A-MODY therapy in a select patient population at low risk of Euglycaemic Diabetic Ketoacidosis, as in HNF1A-MODY.
Perspectives
Treatment for MODY is becoming increasingly personalised. While sulfonylureas remain the standard therapy for HNF4A-MODY, newer agents such as SGLT2 inhibitors may offer effective glycaemic control while reducing reliance on sulfonylureas or insulin. This could provide greater treatment choice and avoid some of the practical and lifestyle limitations associated with traditional therapies. People with rarer forms of Diabetes should not be left behind medical advancements just because their condition makes it harder to prove it safe.
Christopher Philbey
Harrogate District Hospitals NHS Foundation Trust
Read the Original
This page is a summary of: Effective Sulfonylurea-Sparing First-Line HNF4A-MODY Therapy With Sodium-Dependent Glucose Cotransporter 2 Inhibitors, Diabetes Care, September 2026, American Diabetes Association,
DOI: 10.2337/dc26-1631.
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