My daughter was diagnosed last August with MODY. She is 11 years old and thin, 5 feet, 1 inch and 80 pounds. At the time, her A1c was 6.2. Her A1c was 6.6 three months ago and 6.9 last week. We test twice a day and her fasting blood sugars are between 115 and 126 mg/dl [6.4 and 7.0 mmol/L]. Her postprandials are 130 to 180 mg/dl [7.2 to 10.0 mmol/L] with an occasional 200 mg/dl [11.1 mmol/L]. We saw the specialist yesterday and more testing is being done to determine if she does indeed have MODY. My question is about the course of treatment that will be best for her. Until now, she has not been on any medication or insulin. However, with the recent A1c of 6.9, the doctor feels it is time. He presented us with two options, a low dose of Lantus once a day or oral Glucophage twice a day. We were prepared for the insulin option because we were told in the past that because of her age, oral medications wouldn’t be an option. But, we were told yesterday that new research and recent studies show that oral medications like Glucophage are now being used in children. My concern is about giving my daughter a medication that children have only recently been taking. Is she safer with Lantus?

There is actually about a decade of experience with metformin (Glucophage) in children and adolescents. Our own experience mirrors that of our colleagues in that metformin works similarly in adults as well as kids, same gastrointestinal side effects and same general benefits in terms of helping to reduce insulin resistant states.

The key question that I have after reading your questions is: how was the diagnosis of MODY made. Were there genetic tests done? Are you seeing a pediatric diabetologist or pediatric endocrinologist? Were pancreatic antibody tests done?

Assuming that the diagnosis is correct and the blood glucose levels are not at target range, then one could use metformin or any of the other oral agents. Similarly, one could also use insulin. Lantus would be reasonable, as would any combination of insulins. The main goal remains the same for type 1 or type 2 diabetes, near-normalization of pre and postprandial glucose levels without significant hypoglycemia. So, twice-a-day blood glucose monitoring is probably insufficient to answer such questions and I would suggest more intensive monitoring over a one to two week time period and then looking back to analyze where the problems reside, what therapy may work, changes in food, types of carbohydrates, etc. If you work closely with your diabetes team and provide sufficient data, it should become obvious which is the next step based upon the actual blood glucose data.

SB