However, recent studies have noted a higher prevalence of insulin-deficient phenotypes among minority populations, such as African Americans, suggesting that our findings may have broader global relevance.33,42 Furthermore, prior studies have shown that individuals classified as having SIDD may transition to milder insulin-deficient subtypes over time.43 Consistent with this, we also identified milder forms of insulin-deficient diabetes (MIDD) in our cohort. Here, INS is linked to maternally-inherited diabetes and deafness.