We thank Blanco et al. (1) for their letter on our article, which confirmed the utility of high-sensitivity C-reactive protein (hs-CRP) as a clinical biomarker to discriminate patients with HNF1A-MODY from patients with type 2 diabetes (2).

We agree with the authors that the discrimination between HNF1A-MODY and type 2 diabetes is likely to be enhanced by elevated levels of hs-CRP in type 2 diabetes as a result of mild chronic inflammation and fatty liver in combination with the unique mechanism of decreased levels of CRP expression in HNF1A-MODY. This is consistent with our findings that hs-CRP has the greatest clinical utility to distinguish between HNF1A-MODY and type 2 diabetes than between other diabetes subgroups (24).

Since the initial article by Owen et al. (3), these results have been replicated in over 700 patients with confirmed HNF1A-MODY across nine European centers using five different hs-CRP analytical platforms. All of these studies found that hs-CRP distinguished HNF1A-MODY from type 2 diabetes with a high diagnostic accuracy, with the C-statistic ranging from 0.79 to 0.97 (25). These results indicate that hs-CRP is a robust test that can be used to aid in the identification of HNF1A-MODY patients. The wide availability and low-cost of the hs-CRP test means it could be readily used in routine clinical practice.

A.T.H. is supported by the National Institute for Health Research Peninsula Clinical Research Facility, University of Exeter. A.L.G. is a Wellcome Trust Senior Fellow in Basic Biomedical Science (095101/Z/10/Z). K.R.O. is a National Institute for Health Research–funded Clinician Scientist. The study was funded by the European Commission FP7 programs CEED3 (HEALTH-F2-2008-223211).

No potential conflicts of interest relevant to this article were reported.

1.
Blanco
J
,
Costa
A
,
Giménez
M
,
Conget
I
.
Comment on: McDonald et al. High-sensitivity CRP discriminates HNF1A-MODY from other subtypes of diabetes
.
Diabetes Care
2011
;
34
:
1860
1862
(Letter). Diabetes Care 2011;34:e186. DOI: 10.2337/dc11-1654
2.
McDonald
TJ
,
Shields
BM
,
Lawry
J
, et al
.
High-sensitivity CRP discriminates HNF1A-MODY from other subtypes of diabetes
.
Diabetes Care
2011
;
34
:
1860
1862
3.
Owen
KR
,
Thanabalasingham
G
,
James
TJ
, et al
.
Assessment of high-sensitivity C-reactive protein levels as diagnostic discriminator of maturity-onset diabetes of the young due to HNF1A mutations
.
Diabetes Care
2010
;
33
:
1919
1924
4.
Thanabalasingham
G
,
Shah
N
,
Vaxillaire
M
, et al
.
A large multi-centre European study validates high-sensitivity C-reactive protein (hsCRP) as a clinical biomarker for the diagnosis of diabetes subtypes
.
Diabetologia
2011
;
54
:
2801
2810
5.
Kyithar
M
,
Bacon
S
,
Bonner
C
, et al
.
PSP/Reg and hsCRP serum levels may discriminate HNF1A from HNF4A-MODY (Abstract)
.
Diabetes
2011
;
60
(
Suppl.1
):
A541
A542
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