Study unravels secrets of ‘mysterious’ form of diabetes that affects millions

Scientists have found that a mysterious form of diabetes, known as malnutrition-related diabetes, affects tens of millions of people in Asian and sub-Saharan African countries. The advance could lead to new treatments for those affected.

The disease, known as “low BMI diabetes (LD),” mainly affects thin and impoverished adolescents, and young adults who rarely live more than a year after diagnosis, according to the study published recently in the journal Diabetes Care.

While the victims are young and thin, suggesting they may have type 1 diabetes (T1D), researchers, including those from Christian Medical College in Vellore, India, say insulin injections usually don’t help them, and can even cause death from low blood sugar.

Patients also do not seem to have type 2 diabetes (T2D), which is typically associated with obesity.

While this rare form of the disease was first described nearly 70 years ago, researchers say doctors are unsure how to treat the condition due to a lack of research into it.

“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,” Meredith Hawkins, professor of medicine at Albert Einstein College of Medicine in the US, said in a statement.

“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,” Dr Hawkins added.

In the study, scientists used state-of-the-art techniques for assessing insulin secretion and insulin action on 20 males aged between 19 and 45 identified as likely to have malnutrition-related diabetes.

Groups of individuals with type 1 and type 2 diabetes, as well as healthy controls, underwent the same metabolic tests and served as control groups in the study.

“These studies are the first to demonstrate that LD individuals in LMICs [low- and middle-income countries] have a unique metabolic profile, suggesting that this is a distinct entity that warrants further investigation,” scientists wrote in the study.

Citing one limitation of the study, researchers said the analysis was limited to male participants.

They reason that this was done since males account for about 85 per cent of people who develop malnutrition-related diabetes.

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

While earlier findings suggested that malnutrition-related diabetes stemmed from insulin resistance, the new findings reveal that people with malnutrition-related diabetes have a very profound defect in insulin secretion – which wasn’t recognised before.

“This new finding totally revolutionises how we think about this condition and how it should be treated,” Dr Hawkins said.

With the new discovery, scientists say many new drugs that have recently become available for treating type-2 diabetes and boost insulin secretion can raise the possibility of finding safe and effective ways to treat the condition.

“Diabetes has become a true global pandemic. One in 10 adults worldwide has the disease, and three-quarters of them—some 400 million people—live in low- and middle-income countries,” Dr Hawkins said.

“In those countries where it’s been studied, the prevalence of malnutrition-related diabetes among people with diabetes is about 20 per cent, meaning that about 80 million people may be affected worldwide. So we clearly need to learn a lot more about malnutrition-related diabetes and how best to treat it,” she added.