Scientists have discovered a new type of diabetes that affects millions of people

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

New research explores 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 often thin and poor teenagers and young adults, survive more than a year after diagnosis. Their age and frail appearance suggest type 1 diabetes (T1D), but insulin injections are often ineffective and can even cause low blood sugar. Additionally, none of the people appeared to have type 2 diabetes (T2D), which is often associated with obesity. Although the disease was documented about 70 years ago, doctors do not know how to treat the disease due to a lack of research.

A major step toward treatment

Meredith Hawkins, MD, MS, founding director of the Einstein Global Diabetes Institute, has spent the past 12 years leading an international collaborative effort to identify the underlying metabolic defects that lead to diabetes malnutrition, an important first step in developing effective diabetes. to treat. Dr. Hawkins and colleagues demonstrated that malnutrition-related diabetes is metabolically distinct from T1D and T2D and should be considered a distinct type of diabetes in the first careful examination of poorly known patients. Their research was recently published in the journal Diabetes care.

“The current scientific literature provides no guidelines for the management of diet-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 Block Chair in Medicine at Einstein. “Doctors in those countries read western medical journals, so they don’t know about diabetes related to poor nutrition and don’t suspect it in their patients. We hope that our findings will increase awareness of this devastating disease and lead to more effective treatment strategies.

Studying the role of insulin

in cooperation with Dr. Hawkins and other members of the Global Diabetes Institute, the study was conducted at the famous Christian Medical College in Vellore, India. The researchers comprehensively evaluated the metabolism of 20 men aged 19 to 45 years who were more likely to develop diabetes associated with a poor diet using modern methods to measure insulin secretion and action. The same metabolic tests were performed in groups of T1D, T2D and healthy controls for comparison. Males account for approximately 85% of malnourished diabetics, so the study subjects were exclusively male to reduce gender bias.

“We used very sophisticated methods to study these people carefully and carefully – and our findings differ from previous clinical observations,” said Dr. Hawkins.

Specifically, previous findings suggested that diabetes associated with poor nutrition is caused by insulin resistance. (The hormone insulin in the blood can enter the body’s cells for energy; in insulin resistance, blood glucose rises to toxic levels because the cells no longer respond to the person’s own insulin.) “But this,” said Dr. Hawkins, “is the most common cause of diabetes in people with malnutrition.” humans have a previously unrecognized profound defect in insulin secretion. This new finding completely changes how we think about this condition and how we should treat it.

Good news, according to Dr. Many new drugs have recently become available to treat T2D, some of which increase insulin secretion from the pancreas — raising the possibility of finding safer and more effective treatments for the condition, Hawkins said.

“Diabetes has become a real global pandemic,” said Dr. Hawkins noted. “One in 10 adults worldwide has the disease, and three-quarters of them – about 400 million people – live in low- and middle-income countries,” he said. “In the countries studied, the prevalence of diet-related diabetes among people with diabetes is about 20%, which means that about 80 million people worldwide are affected. By comparison, an estimated 38 million people are now living with HIV/AIDS. So we need to know more about diabetes related to poor nutrition and how to treat it.

Reference: Eric Lontchi-Yimagow, Riddhi Dasgupta, Shajit Anup, Sylvia Kelenbrink, Sudha Koppaka, Akankasha Goyal, Padmanaban Venkatesan, Roshan Yevingston, Miilleya, Kennila, “Atypical Diabetes in People with Low BMI” Arun Jose, Grace Rebekah, Anneka Wickramanayake, Mini Joseph, Priyanka Mathias, Anjali Manavalan, Mathews Edatharayil Kurian, Mercy Inbakumari, Flori Christina, Daniel Steyn, Nihal Thomas and Meredith Hawkins May 27, 2022 Diabetes care.
DOI: 10.2337/dc21-1957

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