Type 2 with Glycosuria, a New Diabetes Subtype?

Individuals with type 2 diabetes and glycosuria are found to be younger, thinner, and have lower insulin resistance and blood pressure. SLC5A2 and HNF1A mutations could be responsible for increased urinary glucose excretion. 

Perhaps not a coincidence that diabetes treatment with glycosuria-inducing agents (SGLT2-inhibitors: Jardiance, Invokana, Farxiga) can lead to polyuria, weight loss and decreased blood pressure.


J   C   E   M

Observational Study

May 2017

Context: A sodium glucose cotransporter 2 (SGLT2) inhibitor, which increases urinary glucose excretion, was reported to decrease blood glucose levels and deaths among patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease. SLC5A2 and HNF1A mutations are associated with renal glycosuria, but their contributions to renal glycosuria in patients with T2DM are not well understood.

Objective: To assess the clinical features of patients with T2DM and renal glycosuria and those with T2DM and low urinary glucose excretion (LUGE) and identify variants in the exons of SLC5A2 and HNF1A in patients with renal glycosuria and T2DM.

Design: A total of 2044 Chinese patients with T2DM, including 64 patients with renal glycosuria and 58 patients with LUGE, were tested for their plasma and urine glucose concentrations after fasting. SLC5A2 and HNF1A exons were sequenced.


Compared with patients with LUGE, those with renal glycosuria were younger (P = 0.008), had lower BMI (P = 0.002) and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) values (P < 0.0001), and were less likely to have hypertension (P = 0.006).

HOMA-IR and BMI were negatively associated with renal glycosuria after adjusting for age, sex, hypertension, and insulin therapy. One novel mutation (V359G) of SLC5A2 in 32 patients with renal glycosuria and one known mutation (R131W) of HNF1A in 28 nonobese patients with renal glycosuria were identified.


These findings suggest that there are subtypes of T2DM characterized by different urinary glucose excretion and cardiovascular risk factors. SLC5A2 and HNF1A mutations partially explain renal glycosuria in patients with T2DM.