Latest news with #NihalThomas
Time of India
02-05-2025
- Health
- Time of India
Access to more tests needed to identify type 5 or lean diabetes
It has for long been conjectured to be a malnutrition-related form of diabetes, but has only now been officially recognized as 'Type 5' diabetes at the World Diabetes Congress in Bangkok last week. This comes 70 years after this type of diabetes was first reported. One of the lead authors of the path-breaking physiological study which established that lean diabetes is different from other kinds of the condition, Dr Nihal Thomas , professor of endocrinology at CMC Vellore , explains the implications for the efforts to prevent and treat diabetes in India and the world. What is the prevalence of this kind of diabetes? It is estimated that there are 25 million cases across the world. However, considering that a significant proportion of populations in sub-Saharan Africa, South and Southeast Asia belong to the lower socioeconomic category, the number could be much higher. What is happening in war-torn areas of Africa like Sudan and parts of the Congo? We really do not know. Right now, Type 2 is the most prevalent. A lower prevalence of Type 5 could be because of these cases being wrongly identified as Type 1 and Type 2 diabetes, not having the criteria and access to tests to identify Type 5, and a survey bias. We need to do at least two tests to establish it is Type 5, an ultrasound scan of the pancreas to rule out chronic pancreatitis and c-peptide test to measure the level of c-peptide in the blood, which can tell you how much insulin the body is producing. C-peptide is a by-product of insulin production from the pancreas. And GAD antibodies to rule out Type 1 diabetes. We will have to make these tests widely available so that Type 5 can be correctly diagnosed to help patients better. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Free P2,000 GCash eGift UnionBank Credit Card Apply Now Undo How would the treatment differ? Unlike Type 2 diabetes, which involves resistance to insulin, in Type 5 diabetes insulin resistance is not a feature. When the body cannot produce enough insulin it can lead to ketoacidosis, a condition where the body starts burning fat for energy, instead of sugars, which happens in Type 1 diabetes However, ketoacidosis does not happen in Type 5 diabetes. It appears that at least 50% of Type 5 diabetes patients can be treated with tablets and might not need insulin. But a lot of research is needed to determine what works best for managing and treating Type 5 patients. Some of them do need insulin therapy. Is that a subset of Type 5 diabetes? These are research questions that need to be taken up. The usual advice for diabetes patients is to cut down consumption and increase physical exercise. What would be the recommendations for a person with malnutrition-related diabetes? Insulin secretion is not just dependent on carbohydrates or glucose for stimulating it. It is also dependent on amino acids, which are the building blocks for proteins, and can also stimulate insulin production. So, will a high protein diet help? We do not know. In our study we found that many with Type 5 diabetes were habituated to a low-protein diet. We prescribed them standard diets but found that they gained some weight, but never really became obese. They improved but remained underweight. We recommend a high calorie diet . How high is something we need to find out. Though most people from lower socioeconomic sections are into physical labour, not everyone is. So, we recommend some amount of resistance exercise. We need much more research on the ground in clinical settings to determine what works for them. If it was identified 70 years back, why was it retracted from the WHO classification as a distinct form of diabetes? The first case was identified in Jamaica in 1955. In India, Dr BB Tripathy in Cuttack also documented cases of individuals with low BMI and diabetes from 1963 onwards. Such cases were documented in many countries including Bangladesh, Nigeria, Ethiopia Uganda, and India. It was formally recognized by the WHO in 1985, promoted by Prof Jasbir Bajaj , as a distinct form of diabetes called malnutrition related diabetes mellitus (MDRM). However, with a lack of proper physiological studies over the next 10-15 years to establish it as a distinct type, in 1999 MDRM was omitted from the classification. The people affected by it being mostly impoverished and having little support may have been an additional factor in less attention being given to its potential existence. Moreover, calling it malnutrition-related diabetes was probably not something which would encourage acknowledging it. It was unlikely that a policy maker would be too keen on saying that malnutrition was an issue in any country. A patient would also not like to have a title such as "malnutrition modulated..." for a disease. Giving it a novel nomenclature would help in addressing these issues in part, thereby fostering greater research and policy making capacity in this regard. Cumulative research from cohorts, animal studies and epidemiology from low-income populations in Asia and Africa, has shown that having antenatal undernutrition (low birth weight) along with postnatal undernutrition (childhood undernutrition) may be responsible for this condition, a lot of work being done, particularly by Prof Chittaranjan Yajnik from Pune and Prof Allan Vaag from Copenhagen. Why did it take so long to identify this as a distinct type of diabetes For this to be acknowledged as a distinct type of diabetes, we have to rule out all other causes for diabetes like Type 1 and 2. We had to rule out a condition called fibro calculous pancreatic diabetes occurring in tropical regions and characterized by stones in the pancreas, and which, like Type 5, showed inadequate production of insulin rather than insulin resistance. We also had to rule out genetic disorders such as maturity-onset diabetes of the young (MODY) which is caused by inherited genetic mutations that affect the body's ability to produce insulin. We had to identify lean people with diabetes and rule out all these other conditions. The basic science study involving high end research, done by CMC Vellore in collaboration with the Albert Einstein College of Medicine in New York, took eight years, with committed and trained support staff implementing a tedious protocol and informed consent from patients willing to cooperate with repeated tests and close monitoring. It took time to establish beyond doubt that this was a distinct form of diabetes. Though it is still not back into the WHO classification, it has been endorsed at the World Congress of Diabetes in April 2025 by Dr Peter Schwarz , the president of the International Diabetes Federation, and is still on the International Classification of diseases (ICD).
Express Tribune
22-04-2025
- Health
- Express Tribune
New Type 5 diabetes officially recognised, impacts 25m people worldwide
Previously misunderstood and often misdiagnosed, Type 5 diabetes – also known as malnutrition-related diabetes or Maturity Onset Diabetes of the Young (MODY) – disproportionately affects lean adolescents and young adults, especially in low and middle-income countries across Asia and PEXELS Listen to article A rare and long-overlooked form of diabetes, linked not to obesity but to malnutrition, has been formally recognised by the International Diabetes Federation (IDF) as 'Type 5 diabetes' — a landmark moment for global health experts and patients alike. Previously misunderstood and often misdiagnosed, Type 5 diabetes – also known as malnutrition-related diabetes or Maturity Onset Diabetes of the Young (MODY) – disproportionately affects lean adolescents and young adults, especially in low and middle-income countries across Asia and Africa. The IDF's official recognition came via a formal vote at the World Diabetes Congress in Bangkok on 8 April, marking decades of medical debate. Experts say this rare form of diabetes, which develops in teenagers and young adults due to prolonged nutritional deficiencies, affects an estimated 25 million people worldwide. Unlike the more widely known types of diabetes, which are typically linked to obesity, genetics, or autoimmune responses, Type 5 stems from long-term malnutrition. It leads to poor insulin production due to pancreatic beta cell dysfunction, making standard insulin-based treatments risky and potentially fatal. Professor Meredith Hawkins of the Albert Einstein College of Medicine, who has long advocated for its recognition, welcomed the IDF's decision, saying: 'The IDF's recognition of Type 5 diabetes is an important step toward raising awareness of a health problem that is so devastating to so many people.' She added that the disease had been 'vastly underdiagnosed and poorly understood' for decades. Her research has shown that insulin therapy, often misapplied in these patients, can cause dangerous drops in blood sugar due to the unique metabolic characteristics of the disease. The condition was first observed in Jamaica in the 1950s and was temporarily included in the World Health Organization's diabetes classifications in the 1980s before being removed in 1999 due to insufficient data. However, over the past two decades, physicians across developing countries have increasingly reported seeing young, underweight patients who do not respond to typical insulin treatments. Many of these cases were initially misdiagnosed as Type 1 diabetes. Dr Nihal Thomas of India's Christian Medical College, and a member of the Type 5 Diabetes Working Group, said the disease is 'largely inherited' and requires more targeted research and diagnosis protocols. 'Due to the lack of formal recognition, this condition has been understudied and misdiagnosed. Recognition by the IDF opens the door to better diagnosis and more tailored therapies,' Dr Thomas added. Experts emphasise that Type 5 diabetes is more common than tuberculosis and nearly as widespread as HIV/AIDS in some regions. However, the absence of an official classification until now has limited research funding, public awareness, and therapeutic innovation. With formal recognition now in place, health organisations hope the spotlight on Type 5 diabetes will drive efforts to develop diagnostic tools, train healthcare providers, and ensure effective, non-insulin-based treatment strategies for affected populations. The next steps, researchers say, involve increasing global awareness, particularly among health professionals in high-prevalence areas, and pushing for investment into research and public health solutions tailored to the condition.
The Hindu
22-04-2025
- Health
- The Hindu
What is Type 5 diabetes and why is it of concern in India?
Even as India grapples with its estimated 101 million cases of Type 2 diabetes, a new type of diabetes has recently hit the headlines – Type 5. At the International Diabetes Federation's meeting held recently, an announcement was made: a working group is to be formed to develop criteria and guidelines for Type 5 diabetes. Estimates indicate that this form of diabetes affects 25 million people across the world, primarily in Asia and Africa. Though this form of diabetes was first recorded over 75 years ago, there has been very little attention paid to it so far. What is type 5 diabetes? Whom does it affect? What is its burden in India? And Do more resources need to be allocated to fighting it? Guest: Prof Nihal Thomas, senior professor, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore and chair of the IDF Working Group Host: Zubeda Hamid Edited by Sharmada Venkatasubramanian. Listen to more In Focus podcasts:
