Malnutrition-related diabetes is a puzzling form of diabetes that affects tens of millions of individuals 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 individuals in sub-Saharan Africa and Asia. Rarely do its victims, who are mostly skinny and poor teens and young adults, survive more than a year following diagnosis. Their young age and frail appearance point to type 1 diabetes (T1D), yet insulin shots often are ineffective and may even result in low blood sugar deaths. Additionally, none of the individuals seem to have type 2 diabetes (T2D), which is often linked to obesity. Despite the fact that the illness was originally documented about 70 years ago, physicians are still unaware of how to treat it due to a lack of research on the condition.
Key Step Towards a Treatment
The founding director of Einstein’s Global Diabetes Institute, Meredith Hawkins, M.D., M.S., has led an international collaborative effort 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 significantly metabolically distinct from T1D and T2D and should be regarded as a distinct 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.
“Current scientific literature offers no guidance on managing malnutrition-related diabetes, which is rare in high-income nations 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. “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 our findings will increase awareness of this disease, which is so devastating to so many people and will pave the way for effective treatment strategies.”
Investigating Insulin’s Role
In cooperation with Dr. Hawkins and other members of the Global Diabetes Institute, the study was carried out at the renowned Christian Medical College in Vellore, India. The researchers conducted comprehensive metabolic assessments on 20 males aged 19 to 45 who were selected as likely to develop malnutrition-related diabetes using cutting-edge methods for measuring insulin secretion and action. The same metabolic tests were performed on groups of people with T1D, T2D, and healthy controls for the sake of comparison. Males make up roughly 85% of those who acquire diabetes from malnutrition, hence the study’s subjects were exclusively male to reduce sex-specific variability.
“We used highly sophisticated techniques to rigorously and carefully study these individuals—and our conclusions differ from earlier clinical observations,” said Dr. Hawkins.
More specifically, earlier findings had suggested that malnutrition-related diabetes stemmed from insulin resistance. (The hormone insulin enables 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.) “But it turns out,” said Dr. Hawkins, “that people with malnutrition-related diabetes have a very profound defect in insulin secretion, which wasn’t recognized before. This new finding totally revolutionizes how 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 treating T2D, some of which boost insulin secretion from the pancreas—raising the possibility of finding safe and effective ways of treating the condition.
“Diabetes has become a true global pandemic,” Dr. Hawkins noted. “One in 10 adults worldwide has the disease, and three-quarters of them—some 400 million people—live in low- and middle-income countries,” she said. “In those countries where it’s been studied, the prevalence of malnutrition-related diabetes among people with diabetes is about 20%, meaning that about 80 million people may be affected worldwide. For comparison, an estimated 38 million people are now 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 Among Individuals 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, 27 May 2022, Diabetes Care.
DOI: 10.2337/dc21-1957