An Atypical Form of Diabetes Among Individuals With Low BMI

Area of Science:

• Endocrinology and Metabolism
• Diabetes Research
• Nutritional Science

Background:

• Diabetes in individuals with low Body Mass Index (BMI <19 kg/m2) is prevalent in low- and middle-income countries (LMICs).
• Previously classified as "malnutrition-related diabetes mellitus" by the WHO in 1985, this category was withdrawn in 1999.
• The distinct metabolic characteristics of this diabetes form require definition.

Purpose of the Study:

• To define the metabolic characteristics of individuals with low BMI diabetes (LD).
• To establish LD as a distinct form of diabetes.
• To differentiate LD from type 1 diabetes (T1D) and type 2 diabetes (T2D).

Main Methods:

• Metabolic studies in Indian individuals with LD, excluding other known diabetes forms via immunogenetic analysis.
• Comparison with matched groups: lean non-diabetic, T1D, and T2D.
• Assessment of insulin secretion (C-peptide), insulin sensitivity (pancreatic clamp), and lipid content (1H-NMR spectroscopy).

Main Results:

• Lower total insulin secretion in LD compared to lean non-diabetic and T2D groups.
• Significantly lower endogenous glucose production in LD versus T2D.
• Significantly higher glucose uptake in LD versus T2D, with lower visceral adipose tissue and hepatocellular lipids.

Conclusions:

• LD individuals in LMICs exhibit a unique metabolic profile.
• These findings suggest LD is a distinct diabetic entity.
• Further investigation into LD is warranted.