Researchers identify puzzling new type of diabetes affecting millions

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. Its victims, who are mostly skinny and poor teenagers and young adults, rarely survive more than a year after diagnosis. Their young age and fragile appearance indicate type 1 diabetes (T1D), but insulin injections are often ineffective and can even lead to death from hypoglycemia. Additionally, 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 around 70 years ago, doctors still don’t know how to treat it due to a lack of research into the disease.

Key step towards treatment

Founding Director of Einstein’s Global Diabetes Institute, Meredith Hawkins, MD, MS, has led an international collaborative effort over the past 12 years to identify the underlying metabolic defects that drive malnutrition-related diabetes, which is an essential first step in developing treatments. Dr. Hawkins and colleagues have shown that malnutrition-related diabetes is significantly metabolically distinct from T1D and T2D and should be considered as a separate type of diabetes when first thoroughly examining patients with this poorly understood disease. Their research was recently published in the journal Diabetic treatments.

“Current scientific literature offers no guidance on the management of malnutrition-related diabetes, which is rare in high-income countries but exists in more than 60 low- and middle-income countries,” said Dr Hawkins, Professor of Medicine and the Harold and Muriel Chair Block in Medicine at Einstein. “Doctors in these countries read Western medical journals, so they don’t learn about malnutrition-related diabetes and don’t suspect it in their patients. We hope our findings will increase awareness of this disease, which is so devastating to so many, and pave the way for effective treatment strategies.

Investigate the role of insulin

In cooperation 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 conducted comprehensive metabolic assessments on 20 men aged 19 to 45 selected as at risk of developing malnutrition-related diabetes using state-of-the-art methods to measure insulin secretion and action. The same metabolic tests were performed on groups of people with T1D, T2D, and healthy controls for comparison. Males account for approximately 85% of those who develop diabetes from malnutrition, therefore study subjects were exclusively male to reduce gender-specific variability.

“We used highly sophisticated techniques to rigorously and carefully study these individuals, and our findings differ from previous clinical observations,” Dr. Hawkins said.

Specifically, previous findings had suggested that malnutrition-related diabetes stems from insulin resistance. (The hormone insulin allows blood glucose to enter cells in the body to be used for energy; in insulin resistance, blood glucose rises to toxic levels because cells do not respond more to a person’s insulin.) “But it turns out,” Dr. Hawkins said, “that people with malnutrition-related diabetes have a very profound defect in insulin secretion, which n was not recognized before.This new discovery totally 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 to treat T2D, some of which stimulate insulin secretion from the pancreas, opening up the possibility of finding safe and effective ways to treat disease.

“Diabetes has become a truly global pandemic,” Dr. Hawkins noted. “One in 10 adults worldwide has the disease, and three-quarters of them, or some 400 million people, live in low- and middle-income countries,” she said. “In countries where it has been studied, the prevalence of malnutrition-related diabetes in people with diabetes is around 20%, which means that around 80 million people could be affected worldwide. By comparison, an estimated 38 million people are currently 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 people with 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, Diabetic treatments.
DOI: 10.2337/dc21-1957

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