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Children and adults, diagnosed in early adulthood, who have diabetes not characteristic of type 1 or type 2 diabetes that occurs in successive generations (suggestive of an autosomal dominant pattern of inheritance) should have genetic testing for maturity-onset diabetes of the young. A

In both instances, consultation with a center specializing in diabetes genetics is recommended to understand the significance of these mutations and how best to approach further evaluation, treatment, and genetic counseling. E

Monogenic defects that cause β-cell dysfunction, such as neonatal diabetes and MODY, represent a small fraction of patients with diabetes (<5%). Table 2.7 describes the most common causes of monogenic diabetes. For a comprehensive list of causes, see Genetic Diagnosis of Endocrine Disorders ( 82 ).

Table 2.7
View this table:
Table 2.7

Most common causes of monogenic diabetes ( 82 )

Neonatal Diabetes

Diabetes occurring under 6 months of age is termed “neonatal” or “congenital” diabetes, and about 80–85% of cases can be found to have an underlying monogenic cause ( 83 ). Neonatal diabetes occurs much less often after 6 months of age, whereas autoimmune type 1 diabetes rarely occurs before 6 months of age. Neonatal diabetes can either be transient or permanent. Transient diabetes is most often due to overexpression of genes on chromosome 6q24, is recurrent in about half of cases, and may be treatable with medications other than insulin. Permanent neonatal diabetes is most commonly due to autosomal dominant mutations in the genes encoding the Kir6.2 subunit () and SUR1 subunit () of the β-cell K channel. Correct diagnosis has critical implications because most patients with K-related neonatal diabetes will exhibit improved glycemic control when treated with high-dose oral sulfonylureas instead of insulin. Insulin gene () mutations are the second most common cause of permanent neonatal diabetes, and, while treatment presently is intensive insulin management, there are important genetic considerations, as most of the mutations that cause diabetes are dominantly inherited.

Maturity-Onset Diabetes of the Young

MODY is frequently characterized by onset of hyperglycemia at an early age (classically before age 25 years, although diagnosis may occur at older ages). MODY is characterized by impaired insulin secretion with minimal or no defects in insulin action (in the absence of coexistent obesity). It is inherited in an autosomal dominant pattern with abnormalities in at least 13 genes on different chromosomes identified to date. The most commonly reported forms are GCK-MODY (MODY2), HNF1A-MODY (MODY3), and HNF4A-MODY (MODY1).

Clinically, patients with GCK-MODY exhibit mild, stable, fasting hyperglycemia and do not require antihyperglycemic therapy except sometimes during pregnancy. Patients with HNF1A- or HNF4A-MODY usually respond well to low doses of sulfonylureas, which are considered first-line therapy. Mutations or deletions in are associated with renal cysts and uterine malformations (renal cysts and diabetes [RCAD] syndrome). Other extremely rare forms of MODY have been reported to involve other transcription factor genes including () and

Diagnosis

A diagnosis of one of the three most common forms of MODY including GCK-MODY, HNF1A-MODY, and HNF4A-MODY allows for more cost-effective therapy (no therapy for GCK-MODY; sulfonylureas as first-line therapy for HNF1A-MODY and HNF4A-MODY). Additionally, diagnosis can lead to identification of other affected family members.

A diagnosis of MODY should be considered in individuals who have atypical diabetes and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes, although admittedly “atypical diabetes” is becoming increasingly difficult to precisely define in the absence of a definitive set of tests for either type of diabetes. In most cases, the presence of autoantibodies for type 1 diabetes precludes further testing for monogenic diabetes, but the presence of autoantibodies in patients with monogenic diabetes has been reported ( 84 ). Individuals in whom monogenic diabetes is suspected should be referred to a specialist for further evaluation if available, and consultation is available from several centers. Readily available commercial genetic testing following the criteria listed below now enables a cost-effective ( 85 ), often cost-saving, genetic diagnosis that is increasingly supported by health insurance. A biomarker screening pathway such as the combination of urinary C-peptide/creatinine ratio and antibody screening may aid in determining who should get genetic testing for MODY ( 86 ). It is critical to correctly diagnose one of the monogenic forms of diabetes because these patients may be incorrectly diagnosed with type 1 or type 2 diabetes, leading to suboptimal, even potentially harmful, treatment regimens and delays in diagnosing other family members ( 87 ). The correct diagnosis is especially critical for those with GCK-MODY mutations where multiple studies have shown that no complications ensue in the absence of glucose-lowering therapy ( 88 ). Genetic counseling is recommended to ensure that affected individuals understand the patterns of inheritance and the importance of a correct diagnosis.

The diagnosis of monogenic diabetes should be considered in children and adults diagnosed with diabetes in early adulthood with the following findings:

○ Diabetes diagnosed within the first 6 months of life (with occasional cases presenting later, mostly and mutations) ( 83 , 89 )

Y position of the first GPS antenna in body frame. Positive Y is to the right of the origin. Use antenna phase centroid location if provided by the manufacturer.

Z position of the first GPS antenna in body frame. Positive Z is down from the origin. Use antenna phase centroid location if provided by the manufacturer.

X position of the second GPS antenna in body frame. Positive X is forward of the origin. Use antenna phase centroid location if provided by the manufacturer.

Y position of the second GPS antenna in body frame. Positive Y is to the right of the origin. Use antenna phase centroid location if provided by the manufacturer.

Z position of the second GPS antenna in body frame. Positive Z is down from the origin. Use antenna phase centroid location if provided by the manufacturer.

Controls the amount of GPS measurement delay that the autopilot compensates for. Set to zero to use the default delay for the detected GPS type.

Determines which of the accuracy measures Horizontal position, Vertical Position and Speed are used to calculate the weighting on each GPS receiver when soft switching has been selected by setting GPS_AUTO_SWITCH to 2

Controls the slowest time constant applied to the calculation of GPS position and height offsets used to adjust different GPS receivers for steady state position differences.

GRIP_ENABLE: Gripper Enable/Disable

Gripper enable/disable

GRIP_TYPE: Gripper Type

Gripper enable/disable

PWM value in microseconds sent to Gripper to initiate grabbing the cargo

PWM value in microseconds sent to Gripper to release the cargo

PWM value in microseconds sent to grabber when not grabbing or releasing

Time in seconds that gripper will regrab the cargo to ensure grip has not weakened; 0 to disable

GRIP_UAVCAN_ID: EPM UAVCAN Hardpoint ID Sale Visa Payment Womens Kleid Wirk Short Sleeve Dress More amp; More Outlet New Styles lIn3l4

Refer to https://docs.zubax.com/opengrab_epm_v3#UAVCAN_interface

H_SV1_POS: Servo 1 Position

Angular location of swash servo #1 - only used for H3 swash type

H_SV2_POS: Servo 2 Position

Angular location of swash servo #2 - only used for H3 swash type

H_SV3_POS: Servo 3 Position

Angular location of swash servo #3 - only used for H3 swash type

H_TAIL_TYPE: Tail Type

Tail type selection. Simpler yaw controller used if external gyro is selected

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Swash Type Setting

H_GYR_GAIN: External Gyro Gain

PWM in microseconds sent to external gyro on ch7 when tail type is Servo w/ ExtGyro

Only for H3 swashplate. If pitching the swash forward induces a roll, this can be correct the problem

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