Research into a type of diabetes which affects tens of millions of people in low-income countries has led to a better understating of the condition and hopes that new drugs could be used to treat it.

Malnutrition-diabetes affects people in Asian and sub-Saharan African countries, and those with the condition are normally thin, disadvantaged teenagers and young adults who very often die within a year of being diagnosed.

A lack of research into the condition, which is not thought to be type 1 or 2 diabetes, has meant there is little treatment available, but a recent study has helped scientists understand more about it and could pave the way for new treatments.

Dr Meredith Hawkins, founding director of Einstein’s Global Diabetes Institute, has spent 12 years leading a world-wide effort to identify the metabolic defects that lead to malnutrition-related diabetes.
Now the team has reported that malnutrition-related diabetes is very different metabolically to type 1 and 2 diabetes.

Dr Hawkins said: “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.

“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.”

Metabolic evaluations were carried out on 20 men aged 19 to 45 who were identified as likely to have malnutrition-related diabetes. The same tests were conducted on people with type 1 and 2 diabetes and those without diabetes.

The findings differed from previous studies, with Dr Hawkins saying: “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.”
It means that those with the condition could benefit from new drugs which boost insulin secretion from the pancreas.

Dr Hawkins added: “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.”

The study has been published in the journal Diabetes Care.

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