Diabetes in rural individuals of different nutritional status and the alarming situation demands focus more on its under-nutrition association

Maiti, Smarajit; Sinha, Nirmalya Kumar; Khan, Md. Mobidullah; Das, Prasanta Kumar; Chattopadhyay, Jadab Chandra

doi:10.3109/13813455.2014.959973

Cited by 6 publications

(4 citation statements)

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“…Maternal protein malnutrition has been studied in rodents, with reports of offspring born to these mothers having lower β-cell mass and decreased ability for β-cell regeneration. Remarkably, while early life malnutrition or starvation can predispose to T2D in adulthood ( 10 , 25 , 49 , 50 ), what distinguishes LD from T2D subjects is that the former remain underweight throughout their development ( 16 ). In humans, small-for-gestational-age neonates are noted to have a smaller fraction of islet cells and less pancreatic vasculature ( 51 ).…”

Section: Discussionmentioning

confidence: 99%

“…Maiti et al ( 16 ) recently reported that underweight individuals (BMI <18.5 kg/m 2 ) with diabetes in rural India were twice as likely to present with glucose levels >270 mg/dL than those with normal or increased BMI. Among >4,700 individuals with insulin-requiring diabetes in rural Ethiopia, mean BMI was 16.7 kg/m 2 for men and 16.5 kg/m 2 for women, with a two-to-one male predominance ( 7 ), and nearly all patients were ketosis resistant ( 16 ). The investigators subsequently proposed that most of the subjects they studied in Ethiopia were likely to have a nonautoimmune form of diabetes, which they proposed to be MRDM ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, subsequent epidemiologic data continued to support this entity as a unique and fairly prevalent form of diabetes. The estimates of MRDM among patients with diabetes in India and Iran have ranged from $6 to 21%, after exclusion of patients with visible pancreatic pathology (15)(16)(17)(18). Maiti et al (16) recently reported that underweight individuals (BMI <18.5 kg/m 2 ) with diabetes in rural India were twice as likely to present with glucose levels >270 mg/dL than those with normal or increased BMI.…”

mentioning

confidence: 99%

“…The estimates of MRDM among patients with diabetes in India and Iran have ranged from $6 to 21%, after exclusion of patients with visible pancreatic pathology (15)(16)(17)(18). Maiti et al (16) recently reported that underweight individuals (BMI <18.5 kg/m 2 ) with diabetes in rural India were twice as likely to present with glucose levels >270 mg/dL than those with normal or increased BMI. Among >4,700 individuals with insulin-requiring diabetes in rural Ethiopia, mean BMI was 16.7 kg/m 2 for men and 16.5 kg/m 2 for women, with a twoto-one male predominance (7), and nearly all patients were ketosis resistant (16).…”

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An Atypical Form of Diabetes Among Individuals With Low BMI

et al. 2022

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OBJECTIVE Diabetes among individuals with low BMI (<19 kg/m2) has been recognized for >60 years as a prevalent entity in low- and middle-income countries (LMICs) and was formally classified as “malnutrition-related diabetes mellitus” by the World Health Organization (WHO) in 1985. Since the WHO withdrew this category in 1999, our objective was to define the metabolic characteristics of these individuals to establish that this is a distinct form of diabetes. RESEARCH DESIGN AND METHODS State-of-the-art metabolic studies were used to characterize Indian individuals with “low BMI diabetes” (LD) in whom all known forms of diabetes were excluded by immunogenetic analysis. They were compared with demographically matched groups: a group with type 1 diabetes (T1D), a group with type 2 diabetes (T2D), and a group without diabetes. Insulin secretion was assessed by C-peptide deconvolution. Hepatic and peripheral insulin sensitivity were analyzed with stepped hyperinsulinemic-euglycemic pancreatic clamp studies. Hepatic and myocellular lipid contents were assessed with 1H-nuclear magnetic resonance spectroscopy. RESULTS The total insulin secretory response was lower in the LD group in comparison with the lean group without diabetes and the T2D group. Endogenous glucose production was significantly lower in the LD group than the T2D group (mean ± SEM 0.50 ± 0.1 vs. 0.84 ± 0.1 mg/kg · min, respectively; P < 0.05). Glucose uptake was significantly higher in the LD group in comparison with the T2D group (10.1 ± 0.7 vs. 4.2 ± 0.5 mg/kg · min; P < 0.001). Visceral adipose tissue and hepatocellular lipids were significantly lower in LD than in T2D. CONCLUSIONS These studies are the first to demonstrate that LD individuals in LMICs have a unique metabolic profile, suggesting that this is a distinct entity that warrants further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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An Atypical Form of Diabetes Among Individuals With Low BMI

et al. 2022

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An Atypical Form of Diabetes Among Low Body Mass Index Individuals in India

et al. 2021

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Is gestational diabetes mellitus in lean women a distinct entity warranting a modified management approach?

Wadivkar,

Hawkins

2024

Front. Clin. Diabetes Healthc.

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During pregnancy, insulin resistance and impaired insulin secretion may lead to the development of Gestational Diabetes Mellitus (GDM). Although a higher Body Mass Index (BMI) is often cited as a risk factor for the development of GDM, lean pregnant women are also at risk of developing GDM based on evidence from several studies. It is proposed that insulin deficiency (more than insulin resistance) leads to the development of GDM in women with low BMI (BMI <18.5 kg/m2). Neonates of these women are more at risk of preterm birth and small-for-gestational-age. Given this unique pathophysiology and phenotype, this entity needs a modified management approach. This article aims to raise awareness of GDM in lean women to encourage more research on this topic and create a modified management approach.

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Diabetes in rural individuals of different nutritional status and the alarming situation demands focus more on its under-nutrition association

Cited by 6 publications

References 40 publications

An Atypical Form of Diabetes Among Individuals With Low BMI

An Atypical Form of Diabetes Among Individuals With Low BMI

An Atypical Form of Diabetes Among Low Body Mass Index Individuals in India

Is gestational diabetes mellitus in lean women a distinct entity warranting a modified management approach?

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