2. Non-Traditional Forms of Diabetes Worldwide: Implications for Translational Investigation

Balasubramanyam, Ashok; Yajnik, Chittaranjan S.; Tandon, Nikhil

doi:10.1210/team.9781879225824.ch2

Cited by 22 publications

(12 citation statements)

References 51 publications

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“…Upon discontinuation of insulin, the period of near-normoglycemic remission may last for a few months to several years [11–14]. This clinical presentation has been reported primarily in African–Americans (AA) and Latinos [6,7,9,15], but also in other minority ethnic groups [13,16–18]. This variant of T2DM has been referred to in the literature as idiopathic T1DM, atypical diabetes, Flatbush diabetes, diabetes Type 1½ and more recently as ketosis-prone Type 2 diabetes mellitus (KPDM) [8,10,19,20].…”

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confidence: 99%

Update on diagnosis, pathogenesis and management of ketosis-prone Type 2 diabetes mellitus

Smiley

Prakash²,

Umpiérrez³

2011

Diabetes Management

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SUMMARY Diabetic ketoacidosis (DKA) has been considered a key clinical feature of Type 1 diabetes mellitus; however, increasing evidence indicates that DKA is also a common feature of Type 2 diabetes (T2DM). Many cases of DKA develop under stressful conditions such as trauma or infection but an increasing number of cases without precipitating cause have been reported in children and adults with T2DM. Such patients present with severe hyperglycemia and ketosis as in Type 1 diabetes mellitus but can discontinue insulin after a few months and maintain acceptable glycemic control on diet or oral agents. This subtype of diabetes has been referred to as ketosis-prone T2DM. In this article, we reviewed the literature on ketosis-prone T2DM and summarized the epidemiology, putative pathophysiology and approaches to management.

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confidence: 99%

Update on diagnosis, pathogenesis and management of ketosis-prone Type 2 diabetes mellitus

Smiley

Prakash²,

Umpiérrez³

2011

Diabetes Management

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“…Diabetes in lean patients has been described before[32,33]. There are reports on lean diabetes from other regions of South Asia, India, and Africa[29,34,35]. Populations described in these reports were lean, had a history of childhood malnutrition, and had poor socioeconomic status.…”

Section: Discussionmentioning

confidence: 96%

“…Body composition depends on genetic makeup, dietary habits, physical activities, and susceptibility to chronic illness. Lean diabetes has been described in many populations across the world[29,30], and there have been extensive reports on lean diabetes in India. A prospective study across nine centers in India found about one-fourth of T2DM patients to be lean or with BMI below 19 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

Diabetes in the Kokan region of India

Patil¹,

Shruti²,

Maruti³

et al. 2019

WJD

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BACKGROUND BKL Walawalkar Hospital is situated near the village of Dervan in the Kokan region of the state of Maharashtra in India. A survey of 2200 surrounding villages showed 51.8% adults had body mass index (BMI) below <18.5 kg/m 2 and only 4.5% were overweight. A survey of 11521 adolescent girls from rural schools showed 64% prevalence of thinness. In the same region, government survey reported the prevalence of diabetes around 7%, and 70% prevalence of leanness. This reinforced the fact that the overall population of Kokan is lean. Hence, we decided to investigate body composition of diabetic people from our hospital clinic by carrying out a clinic-based case control study. AIM To study body composition of diabetics in a rural clinic of Kokan. METHODS In a case-control study, 168 type 2 diabetic patients (102 men) attending the outpatient department at a rural hospital and 144 non-diabetic controls (68 men) in the Chiplun area of the Kokan region were recruited. History of diabetes (age of onset, duration), anthropometric measurements (height, weight, waist and hip circumference) were recorded. Body composition was measured by bioimpedance using the TANITA analyzer. RESULTS More than 45% of diabetic subjects had a 1 st degree family history of diabetes, and more than 50% had macrovascular complications. The average BMI in diabetic subjects was 24.3 kg/m 2 . According to World Health Organization standards, prevalence of underweight was 8% and that of normal BMI was around 50%. Underweight and normal diabetic subjects (men as well as women) had significantly lower body fat percentage, higher muscle mass percentage, lower visceral fat and lower basal metabolic rate when compared to their overweight counterparts. CONCLUSION The diabetic population in Kokan has near normal body composition, and BMI has considerable limitations in assessing body composition and it also lacks sensitivity for assessing risk for diabetes in this population. High prevalence of family history of diabetes may point towards genetic predisposition. Leanness is an inherent characteristic of this population and its metabolic significance needs further investigations with a larger sample size.

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“…The diversity and heterogeneity are increasingly apparent as the condition manifests itself in different ethnic and racial populations around the world (Balasubramanyam, Tandon, & Yajnik, 2011). Yet most physicians, including endocrinologists, persist in treating this complex condition as a monolithic entity, resulting from the convergence of two vaguely defined and poorly quantifiable “core defects” (insulin resistance and relative insulin deficiency), assertively defined by a single glycemic parameter, and managed by treatment approaches shaped more by habit or consensus than by rational targeting or comparative evidence.…”

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confidence: 99%

“…In regard to clinical management, our treatment paradigms remain speculative so long as they do not target unique characteristics of different forms of T2D. Even if an interplay of insulin response and insulin sensitivity is the necessary final pathway to hyperglycemia (Balasubramanyam et al, 2011), one cannot assume that new onset diabetes in an elderly northern European, a young, lean Indian villager, an older Mexican-American or West African presenting with DKA, and a middle-aged Chinese with beta cell autoantibodies but not requiring insulin, is the result of a singular disease process requiring a common treatment approach.…”

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confidence: 99%