DOI QR코드

DOI QR Code

Impact of type 2 diabetes variants identified through genome-wide association studies in early-onset type 2 diabetes from South Indian population

  • Liju, Samuel (Department of Molecular Genetics, Madras Diabetes Research Foundation) ;
  • Chidambaram, Manickam (Department of Molecular Genetics, Madras Diabetes Research Foundation) ;
  • Mohan, Viswanathan (Department of Molecular Genetics, Madras Diabetes Research Foundation) ;
  • Radha, Venkatesan (Department of Molecular Genetics, Madras Diabetes Research Foundation)
  • Received : 2020.05.05
  • Accepted : 2020.05.26
  • Published : 2020.09.30

Abstract

The prevalence of early-onset type 2 diabetes (EOT2D) is increasing in Asian countries. Genome-wide association studies performed in European and various other populations have identified associations of numerous variants with type 2 diabetes in adults. However, the genetic component of EOT2D which is still unexplored could have similarities with late-onset type 2 diabetes. Here in the present study we aim to identify the association of variants with EOT2D in South Indian population. Twenty-five variants from 18 gene loci were genotyped in 1,188 EOT2D and 1,183 normal glucose tolerant subjects using the MassARRAY technology. We confirm the association of the HHEX variant rs1111875 with EOT2D in this South Indian population and also the association of CDKN2A/2B (rs7020996) and TCF7L2 (rs4506565) with EOT2D. Logistic regression analyses of the TCF7L2 variant rs4506565(A/T), showed that the heterozygous and homozygous carriers for allele 'T' have odds ratios of 1.47 (95% confidence interval [CI], 1.17 to 1.83; p = 0.001) and 1.65 (95% CI, 1.18 to 2.28; p = 0.006) respectively, relative to AA homozygote. For the HHEX variant rs1111875 (T/C), heterozygous and homozygous carriers for allele 'C' have odds ratios of 1.13 (95% CI, 0.91 to 1.42; p = 0.27) and 1.58 (95% CI, 1.17 to 2.12; p = 0.003) respectively, relative to the TT homozygote. For CDKN2A/2B variant rs7020996, the heterozygous and homozygous carriers of allele 'C' were protective with odds ratios of 0.65 (95% CI, 0.51 to 0.83; p = 0.0004) and 0.62 (95% CI, 0.27 to 1.39; p = 0.24) respectively, relative to TT homozygote. This is the first study to report on the association of HHEX variant rs1111875 with EOT2D in this population.

Keywords

Acknowledgement

This study was supported by funding from Indian Council of Medical Research and University of Minnesota through the project 'Diabetes: Genetic Susceptibility in the Asian Indian Population' (RHN/Adhoc/19/2011-2012 dated 13.7.2011). We thank Dr.Myron Gross (University of Minnesota) for all the support. LS was supported by CSIR senior research fellowship.

References

  1. Constantino MI, Molyneaux L, Limacher-Gisler F, Al-Saeed A, Luo C, Wu T, et al. Long-term complications and mortality in young-onset diabetes: type 2 diabetes is more hazardous and lethal than type 1 diabetes. Diabetes Care 2013;36:3863-3869. https://doi.org/10.2337/dc12-2455
  2. Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis 2014;5:234-244. https://doi.org/10.1177/2040622314548679
  3. International Diabetes Federation. IDF Diabetes Atlas. 8th ed. Brussels: International Diabetes Federation, 2017.
  4. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-3027. https://doi.org/10.1007/s00125-011-2291-5
  5. Joshi SR. Diabetes care in India. Ann Glob Health 2015;81:830-838. https://doi.org/10.1016/j.aogh.2016.01.002
  6. Praveen PA, Madhu SV, Mohan V, Das S, Kakati S, Shah N, et al. Registry of youth onset diabetes in India (YDR): rationale, recruitment, and current status. J Diabetes Sci Technol 2016;10:1034-1041. https://doi.org/10.1177/1932296816645121
  7. Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol 2017;5:585-596. https://doi.org/10.1016/S2213-8587(17)30174-2
  8. Mahajan A, Taliun D, Thurner M, Robertson NR, Torres JM, Rayner NW, et al. Fine-mapping type 2 diabetes loci to single-variant resolution using high-density imputation and islet-specific epigenome maps. Nat Genet 2018;50:1505-1513. https://doi.org/10.1038/s41588-018-0241-6
  9. Mohan V. Why are Indians more prone to diabetes? J Assoc Physicians India 2004;52:468-474.
  10. Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci 2013;1281:51-63. https://doi.org/10.1111/j.1749-6632.2012.06838.x
  11. Anuradha S, Radha V, Deepa R, Hansen T, Carstensen B, Pedersen O, et al. A prevalent amino acid polymorphism at codon 98 (Ala98Val) of the hepatocyte nuclear factor-1alpha is associated with maturity-onset diabetes of the young and younger age at onset of type 2 diabetes in Asian Indians. Diabetes Care 2005;28:2430-2435. https://doi.org/10.2337/diacare.28.10.2430
  12. Anuradha S, Radha V, Mohan V. Association of novel variants in the hepatocyte nuclear factor 4A gene with maturity onset diabetes of the young and early onset type 2 diabetes. Clin Genet 2011;80:541-549. https://doi.org/10.1111/j.1399-0004.2010.01577.x
  13. Ang SF, Tan CSH, Wang L, Dorajoo R, Fong JCW, Kon WY, et al. PAX4 R192H is associated with younger onset of type 2 diabetes in East Asians in Singapore. J Diabetes Complications 2019;33:53-58. https://doi.org/10.1016/j.jdiacomp.2018.10.002
  14. Wegner L, Hussain MS, Pilgaard K, Hansen T, Pedersen O, Vaag A, et al. Impact of TCF7L2 rs7903146 on insulin secretion and action in young and elderly Danish twins. J Clin Endocrinol Metab 2008;93:4013-4019. https://doi.org/10.1210/jc.2008-0855
  15. Dabelea D, Dolan LM, D'Agostino R Jr, Hernandez AM, McAteer JB, Hamman RF, et al. Association testing of TCF7L2 polymorphisms with type 2 diabetes in multi-ethnic youth. Diabetologia 2011;54:535-539. https://doi.org/10.1007/s00125-010-1982-7
  16. Silbernagel G, Renner W, Grammer TB, Hugl SR, Bertram J, Kleber ME, et al. Association of TCF7L2 SNPs with age at onset of type 2 diabetes and proinsulin/insulin ratio but not with glucagon-like peptide 1. Diabetes Metab Res Rev 2011;27:499-505. https://doi.org/10.1002/dmrr.1194
  17. Hegele RA, Cao H, Harris SB, Hanley AJ, Zinman B. The hepatic nuclear factor-1alpha G319S variant is associated with early-onset type 2 diabetes in Canadian Oji-Cree. J Clin Endocrinol Metab 1999;84:1077-1082.
  18. Villarreal-Molina MT, Flores-Dorantes MT, Arellano-Campos O, Villalobos-Comparan M, Rodriguez-Cruz M, Miliar-Garcia A, et al. Association of the ATP-binding cassette transporter A1 R230C variant with early-onset type 2 diabetes in a Mexican population. Diabetes 2008;57:509-513. https://doi.org/10.2337/db07-0484
  19. Nair S, Muller YL, Ortega E, Kobes S, Bogardus C, Baier LJ. Association analyses of variants in the DIO2 gene with early-onset type 2 diabetes mellitus in Pima Indians. Thyroid 2012;22:80-87. https://doi.org/10.1089/thy.2010.0455
  20. Ma L, Hanson RL, Que LN, Guo Y, Kobes S, Bogardus C, et al. PCLO variants are nominally associated with early-onset type 2 diabetes and insulin resistance in Pima Indians. Diabetes 2008;57:3156-3160. https://doi.org/10.2337/db07-1800
  21. Prudente S, Scarpelli D, Chandalia M, Zhang YY, Morini E, Del Guerra S, et al. The TRIB3 Q84R polymorphism and risk of early-onset type 2 diabetes. J Clin Endocrinol Metab 2009;94:190-196. https://doi.org/10.1210/jc.2008-1365
  22. Liao WL, Chen CC, Chang CT, Wu JY, Chen CH, Huang YC, et al. Gene polymorphisms of adiponectin and leptin receptor are associated with early onset of type 2 diabetes mellitus in the Taiwanese population. Int J Obes (Lond) 2012;36:790-796. https://doi.org/10.1038/ijo.2011.174
  23. Chidambaram M, Liju S, Saboo B, Sathyavani K, Viswanathan V, Pankratz N, et al. Replication of genome-wide association signals in Asian Indians with early-onset type 2 diabetes. Acta Diabetol 2016;53:915-923. https://doi.org/10.1007/s00592-016-0889-2
  24. Zeggini E, Scott LJ, Saxena R, Voight BF, Marchini JL, Hu T, et al. Meta-analysis of genome-wide association data and large-scale replication identifies additional susceptibility loci for type 2 diabetes. Nat Genet 2008;40:638-645. https://doi.org/10.1038/ng.120
  25. Shu XO, Long J, Cai Q, Qi L, Xiang YB, Cho YS, et al. Identification of new genetic risk variants for type 2 diabetes. PLoS Genet 2010;6:e1001127. https://doi.org/10.1371/journal.pgen.1001127
  26. Diabetes Genetics Initiative of Broad Institute of Harvard and MIT, Lund University, and Novartis Institutes of BioMedical Research, Saxena R, Voight BF, Lyssenko V, Burtt NP, de Bakker PI, et al. Genome-wide association analysis identifies loci for type 2 diabetes and triglyceride levels. Science 2007;316:1331-1336. https://doi.org/10.1126/science.1142358
  27. Rung J, Cauchi S, Albrechtsen A, Shen L, Rocheleau G, Cavalcanti-Proenca C, et al. Genetic variant near IRS1 is associated with type 2 diabetes, insulin resistance and hyperinsulinemia. Nat Genet 2009;41:1110-1115. https://doi.org/10.1038/ng.443
  28. Unoki H, Takahashi A, Kawaguchi T, Hara K, Horikoshi M, Andersen G, et al. SNPs in KCNQ1 are associated with susceptibility to type 2 diabetes in East Asian and European populations. Nat Genet 2008;40:1098-1102. https://doi.org/10.1038/ng.208
  29. Takeuchi F, Serizawa M, Yamamoto K, Fujisawa T, Nakashima E, Ohnaka K, et al. Confirmation of multiple risk loci and genetic impacts by a genome-wide association study of type 2 diabetes in the Japanese population. Diabetes 2009;58:1690-1699. https://doi.org/10.2337/db08-1494
  30. Zeggini E, Weedon MN, Lindgren CM, Frayling TM, Elliott KS, Lango H, et al. Replication of genome-wide association signals in UK samples reveals risk loci for type 2 diabetes. Science 2007;316:1336-1341. https://doi.org/10.1126/science.1142364
  31. Albrechtsen A, Grarup N, Li Y, Sparso T, Tian G, Cao H, et al. Exome sequencing-driven discovery of coding polymorphisms associated with common metabolic phenotypes. Diabetologia 2013;56:298-310. https://doi.org/10.1007/s00125-012-2756-1
  32. Kooner JS, Saleheen D, Sim X, Sehmi J, Zhang W, Frossard P, et al. Genome-wide association study in individuals of South Asian ancestry identifies six new type 2 diabetes susceptibility loci. Nat Genet 2011;43:984-989. https://doi.org/10.1038/ng.921
  33. Saxena R, Elbers CC, Guo Y, Peter I, Gaunt TR, Mega JL, et al. Large-scale gene-centric meta-analysis across 39 studies identifies type 2 diabetes loci. Am J Hum Genet 2012;90:410-425. https://doi.org/10.1016/j.ajhg.2011.12.022
  34. Voight BF, Scott LJ, Steinthorsdottir V, Morris AP, Dina C, Welch RP, et al. Twelve type 2 diabetes susceptibility loci identified through large-scale association analysis. Nat Genet 2010;42:579-589. https://doi.org/10.1038/ng.609
  35. Scott LJ, Mohlke KL, Bonnycastle LL, Willer CJ, Li Y, Duren WL, et al. A genome-wide association study of type 2 diabetes in Finns detects multiple susceptibility variants. Science 2007;316:1341-1345. https://doi.org/10.1126/science.1142382
  36. Qi L, Cornelis MC, Kraft P, Stanya KJ, Linda Kao WH, Pankow JS, et al. Genetic variants at 2q24 are associated with susceptibility to type 2 diabetes. Hum Mol Genet 2010;19:2706-2715. https://doi.org/10.1093/hmg/ddq156
  37. Wellcome Trust Case Control Consortium. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature 2007;447:661-678. https://doi.org/10.1038/nature05911
  38. Gabriel S, Ziaugra L, Tabbaa D. SNP genotyping using the Sequenom MassARRAY iPLEX platform. Curr Protoc Hum Genet 2009;Chapter 2:Unit 2.12.
  39. Barrett JC, Fry B, Maller J, Daly MJ. Haploview: analysis and visualization of LD and haplotype maps. Bioinformatics 2005;21:263-265. https://doi.org/10.1093/bioinformatics/bth457
  40. Cropano C, Santoro N, Groop L, Dalla Man C, Cobelli C, Galderisi A, et al. The rs7903146 variant in the TCF7L2 gene increases the risk of prediabetes/type 2 diabetes in obese adolescents by impairing beta-cell function and hepatic insulin sensitivity. Diabetes Care 2017;40:1082-1089. https://doi.org/10.2337/dc17-0290
  41. Grant SF, Thorleifsson G, Reynisdottir I, Benediktsson R, Manolescu A, Sainz J, et al. Variant of transcription factor 7-like 2 (TCF7L2) gene confers risk of type 2 diabetes. Nat Genet 2006;38:320-323. https://doi.org/10.1038/ng1732
  42. Groves CJ, Zeggini E, Minton J, Frayling TM, Weedon MN, Rayner NW, et al. Association analysis of 6,736 U.K. subjects provides replication and confirms TCF7L2 as a type 2 diabetes susceptibility gene with a substantial effect on individual risk. Diabetes 2006;55:2640-2644. https://doi.org/10.2337/db06-0355
  43. Grarup N, Rose CS, Andersson EA, Andersen G, Nielsen AL, Albrechtsen A, et al. Studies of association of variants near the HHEX, CDKN2A/B, and IGF2BP2 genes with type 2 diabetes and impaired insulin release in 10,705 Danish subjects: validation and extension of genome-wide association studies. Diabetes 2007;56:3105-3111. https://doi.org/10.2337/db07-0856
  44. Cauchi S, El Achhab Y, Choquet H, Dina C, Krempler F, Weitgasser R, et al. TCF7L2 is reproducibly associated with type 2 diabetes in various ethnic groups: a global meta-analysis. J Mol Med (Berl) 2007;85:777-782. https://doi.org/10.1007/s00109-007-0203-4
  45. Ng MC, Tam CH, Lam VK, So WY, Ma RC, Chan JC. Replication and identification of novel variants at TCF7L2 associated with type 2 diabetes in Hong Kong Chinese. J Clin Endocrinol Metab 2007;92:3733-3737. https://doi.org/10.1210/jc.2007-0849
  46. Tabara Y, Osawa H, Kawamoto R, Onuma H, Shimizu I, Miki T, et al. Replication study of candidate genes associated with type 2 diabetes based on genome-wide screening. Diabetes 2009;58:493-498. https://doi.org/10.2337/db07-1785
  47. Bodhini D, Radha V, Dhar M, Narayani N, Mohan V. The rs12255372(G/T) and rs7903146(C/T) polymorphisms of the TCF7L2 gene are associated with type 2 diabetes mellitus in Asian Indians. Metabolism 2007;56:1174-1178. https://doi.org/10.1016/j.metabol.2007.04.012
  48. Chandak GR, Janipalli CS, Bhaskar S, Kulkarni SR, Mohankrishna P, Hattersley AT, et al. Common variants in the TCF7L2 gene are strongly associated with type 2 diabetes mellitus in the Indian population. Diabetologia 2007;50:63-67.
  49. Acharya S, Al-Elq A, Al-Nafaie A, Muzaheed M, Al-Ali A. Type 2 diabetes mellitus susceptibility gene TCF7L2 is strongly associated with hyperglycemia in the Saudi Arabia Population of the eastern province of Saudi Arabia. Eur Rev Med Pharmacol Sci 2015;19:3100-3106.
  50. O'Beirne SL, Salit J, Rodriguez-Flores JL, Staudt MR, Abi Khalil C, Fakhro KA, et al. Type 2 diabetes risk allele loci in the Qatari population. PLoS One 2016;11:e0156834. https://doi.org/10.1371/journal.pone.0156834
  51. Turki A, Al-Zaben GS, Mtiraoui N, Marmmuoch H, Mahjoub T, Almawi WY. Transcription factor-7-like 2 gene variants are strongly associated with type 2 diabetes in Tunisian Arab subjects. Gene 2013;513:244-248. https://doi.org/10.1016/j.gene.2012.10.086
  52. Nemr R, Turki A, Echtay A, Al-Zaben GS, Daher HS, Irani-Hakime NA, et al. Transcription factor-7-like 2 gene variants are strongly associated with type 2 diabetes in Lebanese subjects. Diabetes Res Clin Pract 2012;98:e23-e27.
  53. Gupta V, Khadgawat R, Ng HK, Kumar S, Aggarwal A, Rao VR, et al. A validation study of type 2 diabetes-related variants of the TCF7L2, HHEX, KCNJ11, and ADIPOQ genes in one endogamous ethnic group of north India. Ann Hum Genet 2010;74:361-368. https://doi.org/10.1111/j.1469-1809.2010.00580.x
  54. Chidambaram M, Radha V, Mohan V. Replication of recently described type 2 diabetes gene variants in a South Indian population. Metabolism 2010;59:1760-1766. https://doi.org/10.1016/j.metabol.2010.04.024
  55. Horikoshi M, Hara K, Ito C, Shojima N, Nagai R, Ueki K, et al. Variations in the HHEX gene are associated with increased risk of type 2 diabetes in the Japanese population. Diabetologia 2007;50:2461-2466. https://doi.org/10.1007/s00125-007-0827-5
  56. Lee YH, Kang ES, Kim SH, Han SJ, Kim CH, Kim HJ, et al. Association between polymorphisms in SLC30A8, HHEX, CDKN2A/B, IGF2BP2, FTO, WFS1, CDKAL1, KCNQ1 and type 2 diabetes in the Korean population. J Hum Genet 2008;53:991-998. https://doi.org/10.1007/s10038-008-0341-8
  57. Dupuis J, Langenberg C, Prokopenko I, Saxena R, Soranzo N, Jackson AU, et al. New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk. Nat Genet 2010;42:105-116. https://doi.org/10.1038/ng.520
  58. Zhao J, Schug J, Li M, Kaestner KH, Grant SF. Disease-associated loci are significantly over-represented among genes bound by transcription factor 7-like 2 (TCF7L2) in vivo. Diabetologia 2010;53:2340-2346. https://doi.org/10.1007/s00125-010-1852-3
  59. Lyssenko V, Lupi R, Marchetti P, Del Guerra S, Orho-Melander M, Almgren P, et al. Mechanisms by which common variants in the TCF7L2 gene increase risk of type 2 diabetes. J Clin Invest 2007;117:2155-2163. https://doi.org/10.1172/JCI30706
  60. Zhou Y, Park SY, Su J, Bailey K, Ottosson-Laakso E, Shcherbina L, et al. TCF7L2 is a master regulator of insulin production and processing. Hum Mol Genet 2014;23:6419-6431. https://doi.org/10.1093/hmg/ddu359
  61. Boj SF, van Es JH, Huch M, Li VS, Jose A, Hatzis P, et al. Diabetes risk gene and Wnt effector Tcf7l2/TCF4 controls hepatic response to perinatal and adult metabolic demand. Cell 2012;151:1595-1607. https://doi.org/10.1016/j.cell.2012.10.053
  62. Hannou SA, Wouters K, Paumelle R, Staels B. Functional genomics of the CDKN2A/B locus in cardiovascular and metabolic disease: what have we learned from GWASs? Trends Endocrinol Metab 2015;26:176-184. https://doi.org/10.1016/j.tem.2015.01.008
  63. Kong Y, Sharma RB, Ly S, Stamateris RE, Jesdale WM, Alonso LC. CDKN2A/B T2D genome-wide association study risk SNPs impact locus gene expression and proliferation in human islets. Diabetes 2018;67:872-884. https://doi.org/10.2337/db17-1055
  64. Omori S, Tanaka Y, Takahashi A, Hirose H, Kashiwagi A, Kaku K, et al. Association of CDKAL1, IGF2BP2, CDKN2A/B, HHEX, SLC30A8, and KCNJ11 with susceptibility to type 2 diabetes in a Japanese population. Diabetes 2008;57:791-795. https://doi.org/10.2337/db07-0979
  65. Furukawa Y, Shimada T, Furuta H, Matsuno S, Kusuyama A, Doi A, et al. Polymorphisms in the IDE-KIF11-HHEX gene locus are reproducibly associated with type 2 diabetes in a Japanese population. J Clin Endocrinol Metab 2008;93:310-314. https://doi.org/10.1210/jc.2007-1029
  66. Lin Y, Li P, Cai L, Zhang B, Tang X, Zhang X, et al. Association study of genetic variants in eight genes/loci with type 2 diabetes in a Han Chinese population. BMC Med Genet 2010;11:97.20550665
  67. Kifagi C, Makni K, Boudawara M, Mnif F, Hamza N, Abid M, et al. Association of genetic variations in TCF7L2, SLC30A8, HHEX, LOC387761, and EXT2 with type 2 diabetes mellitus in Tunisia. Genet Test Mol Biomarkers 2011;15:399-405. https://doi.org/10.1089/gtmb.2010.0199
  68. Sanghera DK, Ortega L, Han S, Singh J, Ralhan SK, Wander GS, et al. Impact of nine common type 2 diabetes risk polymorphisms in Asian Indian Sikhs: PPARG2 (Pro12Ala), IGF2BP2, TCF7L2 and FTO variants confer a significant risk. BMC Med Genet 2008;9:59.
  69. Kommoju UJ, Samy SK, Maruda J, Irgam K, Kotla JP, Velaga L, et al. Association of CDKAL1, CDKN2A/B & HHEX gene polymorphisms with type 2 diabetes mellitus in the population of Hyderabad, India. Indian J Med Res 2016;143:455-463. https://doi.org/10.4103/0971-5916.184303
  70. Phani NM, Adhikari P, Nagri SK, D'Souza SC, Satyamoorthy K, Rai PS. Replication and relevance of multiple susceptibility loci discovered from genome wide association studies for type 2 diabetes in an Indian Population. PLoS One 2016;11:e0157364. https://doi.org/10.1371/journal.pone.0157364
  71. Lewis JP, Palmer ND, Hicks PJ, Sale MM, Langefeld CD, Freedman BI, et al. Association analysis in african americans of European-derived type 2 diabetes single nucleotide polymorphisms from whole-genome association studies. Diabetes 2008;57:2220-2225. https://doi.org/10.2337/db07-1319
  72. Wang Y, Qiao W, Zhao X, Tao M. Quantitative assessment of the influence of hematopoietically expressed homeobox variant (rs1111875) on type 2 diabetes risk. Mol Genet Metab 2011;102:194-199. https://doi.org/10.1016/j.ymgme.2010.09.013
  73. Chauhan G, Spurgeon CJ, Tabassum R, Bhaskar S, Kulkarni SR, Mahajan A, et al. Impact of common variants of PPARG, KCNJ11, TCF7L2, SLC30A8, HHEX, CDKN2A, IGF2BP2, and CDKAL1 on the risk of type 2 diabetes in 5,164 Indians. Diabetes 2010;59:2068-2074. https://doi.org/10.2337/db09-1386
  74. Giannini C, Dalla Man C, Groop L, Cobelli C, Zhao H, Shaw MM, et al. Co-occurrence of risk alleles in or near genes modulating insulin secretion predisposes obese youth to prediabetes. Diabetes Care 2014;37:475-482. https://doi.org/10.2337/dc13-1458
  75. Freathy RM, Bennett AJ, Ring SM, Shields B, Groves CJ, Timpson NJ, et al. Type 2 diabetes risk alleles are associated with reduced size at birth. Diabetes 2009;58:1428-1433. https://doi.org/10.2337/db08-1739
  76. Andersson EA, Pilgaard K, Pisinger C, Harder MN, Grarup N, Faerch K, et al. Type 2 diabetes risk alleles near ADCY5, CDKAL1 and HHEX-IDE are associated with reduced birthweight. Diabetologia 2010;53:1908-1916. https://doi.org/10.1007/s00125-010-1790-0
  77. Arterbery AS, Bogue CW. Hhex is necessary for the hepatic differentiation of mouse ES cells and acts via Vegf signaling. PLoS One 2016;11:e0146806. https://doi.org/10.1371/journal.pone.0146806
  78. Zhang J, McKenna LB, Bogue CW, Kaestner KH. The diabetes gene Hhex maintains delta-cell differentiation and islet function. Genes Dev 2014;28:829-834. https://doi.org/10.1101/gad.235499.113
  79. Bort R, Martinez-Barbera JP, Beddington RS, Zaret KS. Hex homeobox gene-dependent tissue positioning is required for organogenesis of the ventral pancreas. Development 2004;131:797-806. https://doi.org/10.1242/dev.00965
  80. Mohan V, Amutha A, Ranjani H, Unnikrishnan R, Datta M, Anjana RM, et al. Associations of beta-cell function and insulin resistance with youth-onset type 2 diabetes and prediabetes among Asian Indians. Diabetes Technol Ther 2013;15:315-322. https://doi.org/10.1089/dia.2012.0259