{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:05:54Z","timestamp":1790017554163,"version":"4.0.1"},"reference-count":32,"publisher":"American Diabetes Association","issue":"10","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"MRC","award":["MR\/T00200X\/1"],"award-info":[{"award-number":["MR\/T00200X\/1"]}]},{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","award":["19\/0005994"],"award-info":[{"award-number":["19\/0005994"]}],"id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","award":["21\/0006335"],"award-info":[{"award-number":["21\/0006335"]}],"id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To evaluate the clinical utility of incorporating a type 1 diabetes genetic risk score (T1DGRS) into monogenic diabetes gene panel testing for individuals referred for suspected maturity-onset diabetes of the young (MODY) from routine clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We studied 1,129 individuals treated with insulin referred for MODY genetic testing. All underwent gene panel testing that included 10 variants to calculate T1DGRS. We compared T1DGRS distributions with reference populations to estimate the type 1 diabetes (T1D) prevalence within referred individuals. We defined age-specific T1DGRS thresholds to identify probable T1D (positive predictive value \u226580%) and applied them in individuals genetically unsolved MODY to assess its utility as a pregenetic testing triage tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>T1DGRS in MODY referral individuals was intermediate between reference populations with and without T1D, consistent with an estimated 20% (95% CI 14.9\u201325.2%) T1D in this real-world setting. After genetic testing, no excess T1DGRS was observed in individuals with genetically solved MODY, whereas those with unsolved MODY showed enrichment consistent with 26.0% T1D, with highest values in children (76.2%) and lowest in adults (16.8%). Age-specific T1DGRS thresholds identified 16.1% (95% CI 13.8\u201318.5%) of genetically unsolved MODY as probable T1D. As a pretesting tool, T1DGRS showed limited discrimination overall (area under the curve [AUC] 0.60) but performed well in children aged &amp;lt;10 years (AUC 0.83), where &amp;gt;50% of tests could be avoided without missing MODY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Incorporating a T1DGRS into routine MODY gene panel testing is feasible and clinically valuable. This approach broadens genomic diagnostics beyond monogenic disease by identifying T1D in individuals with genetically unsolved MODY. Pregenetic testing utility is age dependent and may reduce unnecessary testing in pediatric patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-1081","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T23:01:35Z","timestamp":1787094095000},"page":"1842-1849","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Utility of a Type 1 Diabetes Genetic Risk Score Measured as Part of MODY Genetic Testing"],"prefix":"10.2337","volume":"49","author":[{"given":"Jacques","family":"Murray Leech","sequence":"first","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparajita","family":"Sriram","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Colclough","sequence":"additional","affiliation":[{"name":"Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Foundation Trust 2 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew T.","family":"Hattersley","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayne A.L.","family":"Houghton","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."},{"name":"Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Foundation Trust 2 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Laver","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9240-8104","authenticated-orcid":false,"given":"Kashyap A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Institute of Biomedical and Clinical Sciences, University of Exeter 1 , Exeter, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026092114523678900_B1","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.2337\/dc17-0224","article-title":"Population-based assessment of a biomarker-based screening pathway to aid diagnosis of monogenic diabetes in young-onset patients","volume":"40","author":"Shields","year":"2017","journal-title":"Diabetes Care"},{"key":"2026092114523678900_B2","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1007\/s00125-010-1799-4","article-title":"Maturity-onset diabetes of the young (MODY): how many cases are we missing?","volume":"53","author":"Shields","year":"2010","journal-title":"Diabetologia"},{"key":"2026092114523678900_B3","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s00125-017-4226-2","article-title":"Precision diabetes: learning from monogenic diabetes","volume":"60","author":"Hattersley","year":"2017","journal-title":"Diabetologia"},{"key":"2026092114523678900_B4","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1007\/s00125-011-2418-8","article-title":"The development and validation of a clinical prediction model to determine the probability of MODY in patients with young-onset diabetes","volume":"55","author":"Shields","year":"2012","journal-title":"Diabetologia"},{"key":"2026092114523678900_B5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1111\/cen.14744","article-title":"How do I diagnose maturity onset diabetes of the young in my patients?","volume":"97","author":"Colclough","year":"2022","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2026092114523678900_B6","unstructured":"NHS England\n          . 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