Lifestyle changes not sufficient for type 5 diabetes: How is it treated?
A new type of diabetes was recently recognised by the International Diabetes Federation, called Type 5 Diabetes.Different from type 1 and type 2, type 5 diabetes, also known as 'Maturity-Onset Diabetes of the Young,' mostly affects children for genetic reasons. Since it is rare, it often goes undiagnosed in India. Type 5 diabetes is a genetic condition caused by a mutation in a single gene, the HNF1B gene. It usually begins at a younger age and affects more than just blood sugar. It also spreads to organs like the kidneys, pancreas, and reproductive system.advertisement
HOW IS TYPE 5 DIABETES DIFFERENT?Type 5 diabetes is inherited and typically presents at a younger age. Besides the kidneys, the genetic disease also affects the reproductive system. It is frequently misdiagnosed as type 1 or type 2, since it mimics the symptoms of both forms.According to Dr. Himika Chawla, senior consultant, endocrinology and diabetology at PSRI Hospital, said that the symptoms of type 5 diabetes is broader than type 1 (autoimmune) or type 2 (insulin resistance) as it includes abnormalities in the kidneys and the reproductive system. Diet and exercise are important, but type 5 almost always requires medication to control blood sugar and protect organ function."While a healthy diet and exercise control blood sugar, this type often requires medical intervention. Patients typically need oral antidiabetic drugs or insulin therapy, and given its impact on kidney function, regular monitoring is required," said Dr. Chawla.advertisementWhat makes this type stand out are symptoms beyond blood sugar issues, such as kidney cysts, pancreatic dysplasia, hypomagnesemia, an electrolyte abnormality that may assist diagnosis and electrolyte disturbances, especially low serum magnesium.Failing to correctly diagnose it can mean patients receive inappropriate care, which becomes dangerous if organ complications go undetected.In fact, a 2022 study across 15 countries found that 88.24% of genetically confirmed type 5 diabetes patients were diagnosed before the age of 25, further stressing its early onset and potential for misclassification.HOW IS TYPE 5 DIABETES TREATED?"Unlike type 1 diabetes, insulin (hormone) is not immediately required, and unlike type 2, insulin resistance is not the main issue.Dr. Chawla said, "Patients may respond initially to sulfonylureas, but many will need insulin later." However, research suggests oral antidiabetics like sulfonylureas often underperform, likely due to structural pancreatic defects.New treatment options are being explored, such as GLP-1 medicines like liraglutide that may help some patients by boosting insulin production, even if their organs are not fully developed.Since type 5 diabetes is being recognised by experts, Dr. Chawla stated that the first step is awareness as educating healthcare professionals and incorporating affordable genetic testing our diagnostic processes can improve care for patients in India.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
&w=3840&q=100)
Business Standard
4 days ago
- Business Standard
Tired, hungry and gaining weight? Insulin resistance could be to blame
Have you been feeling more tired lately, gaining weight around the belly despite eating right, or struggling with constant sugar cravings? It might not just be your hectic schedule—it could be insulin resistance, a silent metabolic red flag that's increasingly making its way into Indian households. What is insulin resistance and why is it dangerous? Insulin resistance occurs when cells in your muscles, fat and liver do not respond properly to insulin—a hormone produced by the pancreas that helps regulate blood sugar. Insulin enables glucose to move from your bloodstream into your cells, where it is used for energy. When this process is disrupted, your cells stop responding efficiently to insulin. Over time, this leads to pre-diabetes, type 2 diabetes, heart disease and metabolic syndrome. In simple terms, your body works overtime to keep blood sugar in check, and this chronic strain destabilises glucose levels, leading to serious health risks. 'Your brain cells may not receive enough glucose to function normally if blood glucose levels fall dangerously low (severe hypoglycaemia). This is a serious condition and calls for immediate medical attention,' said Dr Himika Chawla, senior consultant, endocrinology and diabetology, PSRI Hospital. Conversely, if the pancreas produces too little insulin, glucose cannot enter your cells. 'Your blood glucose level rises as glucose accumulates until it becomes too high. This is known as hyperglycaemia. You might develop type 2 diabetes if your blood glucose levels consistently remain high,' added Dr Chawla. Why more Indian families are at risk today According to a study published in the Indian Journal of Endocrinology and Metabolism, the prevalence of insulin resistance among Indian adolescents is rising. Approximately 20–25% of Indian youth aged 10–19 years are affected. With India often labelled the diabetes capital of the world, insulin resistance is a critical precursor. The main drivers of this increase include: Sedentary lifestyles: Desk jobs, long hours and minimal physical activity High-carb, high-sugar diets: Roti, rice and sweets spike insulin levels Stress and poor sleep: Long commutes, excessive screen time and irregular sleep Genetic predisposition: South Asians tend to accumulate visceral fat even at normal weight. Historical food scarcity and famine may also play a role 'Compounding the issue is a cultural shift away from traditional, balanced diets towards refined grains and sugary foods, along with increased screen time and decreased physical activity,' said Dr Jaspreet Singh, endocrinology, Ujala Cygnus Group of Hospitals. Early signs of insulin resistance you should never ignore Insulin resistance often shows up subtly. Watch out for: Constant fatigue Increased hunger, especially for carbohydrates Weight gain around the belly Difficulty losing weight Unintended weight loss Darkened skin around the neck or underarms (acanthosis nigricans) Skin tags Brain fog, trouble focusing or blurry vision High blood pressure or cholesterol Excessive thirst and frequent urination Decreased testosterone, affecting reproductive health and fertility 'Crucially, insulin resistance is not a standalone condition but a driver of metabolic syndrome—a cluster of issues including high blood pressure, high triglycerides, low HDL (good) cholesterol and excess abdominal fat. Together, these greatly elevate the risk of heart disease, stroke and diabetes,' added Dr Singh. 'Gestational diabetes—that is, diabetes during pregnancy—increases the risk of developing insulin resistance. Certain medications, especially glucocorticoids or steroids taken over a long period, can also increase the risk. Medical conditions like polycystic ovarian syndrome, sleep apnoea, acromegaly or Cushing's syndrome are all linked to high insulin resistance. Emerging evidence also suggests that low levels of vitamin D may contribute,' said Dr Pearlsy Grace Rajan, senior consultant, internal medicine, Rela Hospital, Chennai. Lifestyle changes that can reverse insulin resistance The good news is that insulin resistance can often be reversed through lifestyle changes and medical support, especially when caught early. Here is what helps: Move more, sit less: Aim for 30–45 minutes of exercise daily. Even a walk after meals improves insulin sensitivity and helps with sugar cravings 'We need to emphasise resistance or strength training at least thrice a week to build muscle mass, which improves insulin sensitivity,' said Dr Ranjan. Follow a smart plate strategy: 'Be mindful of your carbohydrate intake, and also the time of day you consume them,' added Dr Ranjan. Choose whole grains over white rice or maida, include protein in every meal (dal, eggs, paneer, lean meats), and add fibre through fruits and vegetables. Avoid processed foods and sugary drinks: Packaged snacks, juices and sodas can worsen insulin resistance Prioritise sleep: 7–8 hours of uninterrupted sleep helps regulate blood sugar and appetite hormones Manage stress levels: Yoga, deep breathing, meditation and time away from screens help. Activities like painting or playing music also support stress reduction Tests to diagnose insulin resistance in India Insulin resistance is usually diagnosed through the HOMA-IR (homeostatic model assessment of insulin resistance) test, which measures fasting insulin and glucose levels. The HbA1c test, which shows average blood sugar over 2–3 months, is also useful. These tests are available at most diagnostic labs and typically cost between ₹920 and ₹1,300. How Indian families can tackle it together Insulin resistance is not just a personal health concern—it affects entire families. Shared habits like daily walks, eating home-cooked meals and scheduling check-ups can help Indian households prevent this growing threat. Insulin resistance may be silent, but its consequences are loud. The earlier you act, the better your chances of preventing diabetes and living a full, energetic life. Prevention isn't just better than cure—it's simpler, cheaper and smarter too.
Indian Express
5 days ago
- Indian Express
Should Type 5 diabetes be a category at all? Top diabetologists question lack of evidence, data
Top endocrinologists have questioned the way Malnutrition-Related Diabetes Mellitus (MRDM) has been hastily rechristened as Type 5 diabetes by the International Diabetes Federation (IDF). In an expert review, Dr Anoop Misra (chairman, Fortis C-DOC Hospital for Diabetes and Allied Sciences), Dr Ambrish Mithal (chairman, Endocrinology and Diabetes at Max Healthcare) and Dr Shashank Joshi (diabetologist, Lilavati Hospital, Mumbai) have argued that the new classification runs ahead without robust modern evidence or clearly defined diagnostic criteria. Their critical analysis was published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews recently. 'Reclassifying MRDM as Type 5 diabetes is premature and not supported by current evidence,' they wrote. They argue that MRDM, though first recognised in 1985, was declassified in 1999 due to poor evidence. They say the same holds true today as overlapping symptoms continue to be misleading, the body mass index (BMI) criteria are considered outdated and there is not enough data to warrant a separate type of diabetes. 'We still need rigorous research and definitive biomarkers for such a classification. Besides, there has to be a global consensus,' says Dr Misra. Excerpts: Why can't MRDM be classified as Type 5 diabetes? There's no conclusive evidence that MRDM is a distinct disease rather than a variant or complication of existing diabetes types. Only a distinct phenotype (traits which define the 'what' of a disease) with robust data different from established types merits new classification. MRDM overlaps with other types of diabetes — type 1 (due to autoimmune markers in some cases), type 2 (with insulin resistance or secretory defects), and secondary diabetes (when the pancreas doesn't produce enough digestive enzymes). There's inadequate evidence. Only a few, small-scale studies, such as the 2022 study by Lontchi-Yimagou, exist. Rest are 25-40 year old data, some of which is mostly clinical. These studies are largely cross-sectional and limited in scope, sample size and generalizability. The American Diabetes Association (ADA) and WHO have never formally acknowledged type 3 or type 4 diabetes, making the proposal of a 'type 5' both arbitrary, confusing and unacceptable. What's needed for a classification? A valid classification demands a clearly distinct cause or causes, well-defined diagnostic criteria, international consensus and therapeutic utility. MRDM does not currently satisfy these requirements. Did MRDM ever receive the attention it deserved? The WHO classified it as a separate category in 1985 and it was discussed in international diabetes forums such as the 1976 IDF Congress. However, this attention waned due to the poor quality and limited quantity of research, which was largely descriptive and observational. Eventually, the WHO removed MRDM from its classification in 1999, citing insufficient evidence. In India, MRDM has become increasingly rare. Many experts report not encountering it at all, suggesting its relevance has significantly declined. Should MRDM be treated as a type or a subset of diabetes? MRDM is best viewed not as a separate type of diabetes but as a subset or modified form of existing types, most likely falling under secondary diabetes or as a variant of type 1 or type 2 diabetes. This type is influenced by factors such as chronic undernutrition. Defining it as a distinct 'type' risks oversimplification and could introduce unnecessary confusion in diagnosis and management. What is the classification's impact in India? India historically played a major role in defining and reporting MRDM, contributing to a significant volume of early literature. But MRDM was also reported from many other tropical countries. However, current data reveal a steep decline in the prevalence of undernutrition (proxy by BMI). For instance, thinness among women aged 20–54 dropped from 31.7% in 1999 to 14.2% in 2021. Moreover, many individuals with low BMI in India are constitutionally thin and not necessarily malnourished or unhealthy. Reintroducing MRDM as a major category today risks diverting clinical attention and public health resources away from the pressing and widespread problem of type 2 diabetes, which remains the dominant and surging diabetes burden in India. What more evidence is needed? We need large-scale, prospective cohort studies with long-term follow-up; detailed nutritional, immunological and metabolic profiling; insulin secretion and sensitivity assessments using gold-standard methods; standardized malnutrition definitions; and comprehensive genetic research. Without this evidence base, the proposal to reclassify MRDM is premature, unsubstantiated and unacceptable. How does Type 5 classification hamper treatment protocol? Classifying MRDM as 'Type 5 diabetes' may introduce more confusion than clarity. It suggests a degree of diagnostic and therapeutic precision that does not exist. Moreover, such a label does not provide actionable clinical guidance, as patients show variable insulin needs and mixed autoimmune markers. It could also mislead policymakers and healthcare providers, diverting attention and funding from more prevalent and well-characterized diabetes forms such as type 2.
India Today
28-05-2025
- India Today
From diagnosis to daily care: What every parent should know about juvenile diabetes
Juvenile diabetes, or Type 1 diabetes mellitus (T1DM), is an autoimmune condition where the pancreas produces little to no insulin. Unlike Type 2 diabetes, T1DM is not linked to lifestyle factors and often manifests in children and adolescents. In India, the prevalence of T1DM among children is rising, yet awareness and resources remain GROWING BURDEN IN INDIA India has the highest number of children and adolescents living with T1DM globally. According to the International Diabetes Federation (IDF) Diabetes Atlas 2021, approximately 1.2 million individuals aged 0-19 years are affected worldwide, with India contributing a significant portion. Studies indicate a higher prevalence in urban areas compared to rural regions. For instance, in Karnal, Haryana, the prevalence is 26.6 per 100,000 in urban areas versus 4.27 per 100,000 in rural Mehta, 16, student from Mumbai"Living with Type 1 diabetes isn't about being perfect every day - it's about being prepared. I carry my insulin kit like I carry my phone - always with me, always charged. It's just part of life now."RECOGNISING THE SYMPTOMS Early detection is crucial. Common symptoms include: advertisement A study from B.J. Medical College, Ahmedabad, found that polyuria and polydipsia were present in 81.4% of pediatric T1DM cases."Type 1 diabetes, also called juvenile diabetes, is a disease in which the pancreas makeslittle or no insulin, a hormone that enables sugar to enter cells and be used for energy. Children orteenagers are the most often affected demographic. It is, however, not a resultof lifestyle and cannot be prevented, unlike Type 2 diabetes. Type1 diabetes is an autoimmune disease and is closely related to genetic susceptibility, but there may be environmental factors as well. There is no cure for it, but early diagnosis and lifelong insulin treatment, as well as a strict diet and regular monitoring,help control the disease and prevent complications."Dr. Ritesh Agarwal, Consultant - Endocrinologist, Manipal Hospital, BhubaneshwarMANAGEMENT AND TREATMENTManaging T1DM requires a comprehensive approach:Insulin Therapy: Multiple daily injections or insulin pumpsBlood Glucose Monitoring: Regular checks to maintain optimal levelsDietary Management: Balanced meals with controlled carbohydrate intakePhysical Activity: Regular exercise to improve insulin sensitivityThe Ahmedabad study highlighted that the basal-bolus insulin regimen achieved better glycemic control with fewer hypoglycemic events compared to the split-mix Renu Khanna, Pediatric Endocrinologist "Type 1 diabetes in children is not a lifestyle disease - it's an autoimmune condition that demands lifelong commitment. With the right support, education, and access to insulin, these kids can lead full, active lives just like any other child."CHALLENGES IN INDIAadvertisementDespite medical advancements, several challenges persist:Lack of Awareness: Many are unaware that children can develop Access to Care: Especially in rural areas, access to insulin, monitoring devices, and trained healthcare professionals is Constraints: The cost of lifelong insulin therapy and monitoring can be prohibitive for many Impact: Children may face stigma, leading to emotional and psychological Brij Makkar, President of the Research Society for the Study of Diabetes in India (RSSDI), said in a research report "With an estimated 8.6 lakh T1D patients in India, we cannot afford to overlook the urgent needs of children living with this JUVENILE DIABETES IN INDIA REQUIRES:Enhanced Awareness Campaigns: Educating the public about T1DM symptoms and Healthcare Infrastructure: Ensuring availability of insulin and monitoring tools across the Healthcare Professionals: Specialised training for the early diagnosis and management of paediatric Implementation: Integrating T1DM care into national health programs to provide structured supportBy prioritising these steps, India can improve outcomes for children with T1DM, ensuring they lead healthy and fulfilling Note: This article is for informational purposes and is not a substitute for professional medical advice. Always consult a healthcare provider for diagnosis and Watch
