Sulphonylurea efficacy and end‐organ outcomes in the management of HNF4A ‐ MODY
Authors' conclusion
Individuals with an HNF4A mutation and normal BMI are likely to respond to sulphonylurea therapy. Avoidance of weight gain is associated with ongoing responsiveness to monotherapy. Adjunct therapies including GLP1RA and SGLT2i may play a role in further glycaemic management in addition to renal protective and cardioprotective effects.
Study context
- Population
- Individuals with an HNF4A mutation (HNF4A-MODY), phenotyped in detail incl. OGTT
- Participants
- 42 individuals
- Exposure
- SU monotherapy vs adjunct agents including insulin
- Outcome
- Efficacy of sulphonylurea drugs (HbA1c reduction) during follow-up
Methodological detailslongitudinal follow-up
- Longitudinal follow-up
Main finding
As reported in the abstract
Significant HbA1c reduction on SU monotherapy · 6 years (IQR: 3.5-11) of follow-up
SU monotherapy
51.6%
- HbA1c reduction
- P = 0.045
Observational data: associations, not effects.
Further findings
- Use of adjunct agents including insulin
- 48.4%
- Use of adjunct agents including insulin — Higher BMI with adjunct agents
- p = 0.037
- Use of adjunct agents including insulin — Longer duration of diabetes with adjunct agents
- p = 0.03
- Use of adjunct agents including insulin — Reduced insulin secretory capacity (AUC C-peptide) with adjunct agents
- p = 0.01
Micro- and macrovascular complications
- Retinopathy
- 24.4%
- Nephropathy
- 12.9%
- Coronary heart disease
- 22.6%
Original publication
Sulphonylurea efficacy and end‐organ outcomes in the management of HNF4A ‐ MODY. Diabet Med. Published 15 September 2025. doi:10.
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