When No Treatment Is Right
Reviewed by CDE Mehandi Sharma · Updated
There is one situation in diabetes where the right treatment is no treatment, and GCK-MODY is it.
The reason is mechanical rather than a matter of severity. GCK-MODY resets the glucose sensor in the beta cell, so your body regulates glucose accurately around a slightly higher set point. Medication pushing against that set point is working against a regulated system rather than correcting a fault — which is why treatment for the raised glucose is described as almost always unnecessary and ineffective outside pregnancy, and why oral glucose-lowering agents are specifically not recommended.
The evidence is direct. In the UK study, eight of nine people with GCK-MODY stopped all diabetes treatment, seven of them having previously been on insulin, and their HbA1c was unchanged a year later. The treatment had not been doing anything.
The complication data supports leaving it alone: clinically significant microvascular complications occurred in 1% of GCK-MODY patients against 36% in Type 2 diabetes.
Pregnancy is the exception. There, treatment may be needed depending on whether the baby has inherited the variant, and that is a specialist decision.