SAT-613 - Atypical Diabetes, Atypical Management: A Case of GLP-1 Success in Monogenic Diabetes with Binge Eating Disorder

Introduction:
Monogenic Diabetes, previously known as Maturity-Onset Diabetes of the Young (MODY), is a rare form of diabetes caused by mutations in single genes that impact insulin production, typically diagnosed in individuals under 25 years old. Treatment often involves sulphonylurea or insulin therapy but managing patients with concurrent metabolic and psychological comorbidities can be challenging. This case presents a 26-year-old Hispanic female with HNF1A-MODY and co-existing binge eating disorder (BED), demonstrating the potential of glucagon-like peptide-1 receptor agonists (GLP-1s) to improve both glycemic control and eating behavior.

Case:
A 26-year-old female was diagnosed with HNF1A-MODY at age 10 via genetic testing. Initially, her diabetes was managed with glipizide 2.5 mg twice daily and insulin glargine 8 units. However, her HbA1c remained elevated at 9.8%. Despite dose adjustments to glipizide, glycemic control worsened. She also developed depression and BED, complicating her ability to maintain consistent eating habits and further impairing her glucose control.

Recognizing the need for a more holistic approach, a shared decision was made to initiate treatment with semaglutide, a GLP-1 receptor agonist. Her insulin regimen was discontinued, glipizide was reduced to 10 mg once daily, and semaglutide was started at 0.25 mg weekly, titrated every 8 weeks to 2 mg weekly. Over time, there was notable improvement in both her appetite regulation and glycemic control, with a dramatic reduction in HbA1c from 9.8% to 5.6%.

However, upon re-presentation, the patient reported being off semaglutide for 3 months due to insurance issues, and her HbA1c had risen to 10%.

Discussion:
This case highlights the importance of individualized diabetes management, particularly when psychological conditions such as BED are present. GLP-1 receptor agonists, with their appetite-suppressing effects, may offer a valuable treatment option for selected individuals with eating disorders. These agents appear capable of improving both glycemic control and disordered eating behaviors, making them a useful component in integrated care strategies.

Conclusion:
GLP-1 receptor agonists, like semaglutide, offer promising potential in managing MODY complicated by binge eating disorder, aiding in glycemic control and psychological well-being.

References:
Mehdi AZ, et al. GLP-1 RA and dual GIP/GLP-1 RA treatment in MODY: a descriptive case series. BMJ Open Diabetes Res Care. 2025 Apr 23;13(2):e004885. doi: 10.1136/bmjdrc-2024-004885. PMID: 40274278.

Balantekin KN, et al. The emerging role of glucagon-like peptide 1 in binge eating. J Endocrinol. 2024 May 9;262(1):e230405. doi: 10.1530/JOE-23-0405. PMID: 38642585.

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