Researchers identify a mind-boggling new type of diabetes affecting millions

Human Body Metabolism Energy Concept

Malnutrition-related diabetes is a puzzling form of diabetes that affects tens of millions of people in sub-Saharan Africa and Asia.

A new study investigates a mysterious form of diabetes.

Malnutrition-related diabetes is a mysterious form of diabetes that affects tens of millions of people in Sub-Saharan Africa and Asia. Rarely do the victims, who are mostly skinny and poor teenagers and young adults, survive more than a year after diagnosis. Their young age and frail appearance indicate type 1 diabetes (T1D), but insulin injections are often ineffective and can even lead to deaths from low blood sugar. In addition, none of the individuals appear to have type 2 diabetes (T2D), which is often linked to obesity. Despite the fact that the disease was originally documented about 70 years ago, doctors still don’t know how to treat it due to a lack of research on the condition.

Important step on the way to treatment

The founder and director of Einstein’s Global Diabetes Institute, Meredith Hawkins, MD, MS, has led an international collaboration for the past 12 years to identify the underlying metabolic defects that result in malnutrition-related diabetes, which is an essential first step in developing effective treatments. dr. Hawkins and colleagues have shown that malnutrition-related diabetes is metabolically significantly different from T1D and T2D and should be considered a separate type of diabetes in the first thorough examination of patients with this poorly known condition. Their research was recently published in the journal Diabetes Care.

“The current scientific literature does not provide guidelines for managing malnutrition-related diabetes, which is rare in high-income countries but occurs in more than 60 low- and middle-income countries,” said Dr. Hawkins, professor of medicine and the Harold and Muriel. Block chair of Medicine at Einstein. “The doctors in those countries read western medical journals so they don’t learn about malnutrition-related diabetes and don’t suspect it in their patients. We hope that our findings will raise awareness of this disease, which is so devastating to so many people, and pave the way for effective treatment strategies.”

Research into the role of insulin

In collaboration with Dr. Hawkins and other members of the Global Diabetes Institute, the study was conducted at the renowned Christian Medical College in Vellore, India. The researchers performed comprehensive metabolic assessments on 20 men, ages 19 to 45, who were selected as probable malnutrition-related diabetes using advanced methods of measuring insulin secretion and action. For comparison, the same metabolic tests were performed on groups of people with T1D, T2D and healthy controls. Men make up about 85% of those who develop diabetes from malnutrition, hence the subjects in the study were exclusively males to reduce gender-specific variability.

“We have used very sophisticated techniques to rigorously and carefully study these individuals — and our conclusions differ from previous clinical observations,” said Dr. hawkins.

More specifically, previous findings had suggested that malnutrition-related diabetes arose from insulin resistance. (The hormone insulin allows glucose in the blood to enter the body’s cells to be used for energy; in insulin resistance, glucose in the blood rises to toxic levels because cells no longer respond to a person’s own insulin.) said Dr. Hawkins, “that people with malnutrition-related diabetes have a very profound defect in insulin secretion that has not been recognized before. This new finding completely revolutionizes the way we think about this condition and how it should be treated.”

The good news, according to Dr. Hawkins, is that many new drugs have recently become available for the treatment of T2D, some of which stimulate insulin secretion by the pancreas, increasing the possibility of finding safe and effective ways to treat the condition.

“Diabetes has become a true global pandemic,” noted Dr. Hawkins on. “One in ten adults worldwide has the disease, and three-quarters of them — about 400 million people — live in low- and middle-income countries,” she said. “In the countries where it has been studied, the prevalence of malnutrition-related diabetes among people with diabetes is about 20%, meaning that about 80 million people could be affected worldwide. By comparison, there are now an estimated 38 million people living with HIV/AIDS. So we clearly need to learn a lot more about malnutrition-related diabetes and how best to treat it.”

Reference: “An Atypical Form of Diabetes in Individuals of Low BMI” by Eric Lontchi-Yimagou, Riddhi Dasgupta, Shajith Anoop, Sylvia Kehlenbrink, Sudha Koppaka, Akankasha Goyal, Padmanaban Venkatesan, Roshan Livingstone, Kenny Ye, Aaron Chapla, Michelle Carey , Arun Jose, Grace Rebekah, Anneka Wickramanayake, Mini Joseph, Priyanka Mathias, Anjali Manavalan, Mathews Edatharayil Kurian, Mercy Inbakumari, Flory Christina, Daniel Stein, Nihal Thomas and Meredith Hawkins, May 27, 2022, Diabetes Care.
DOI: 10.2337/dc21-1957

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