Atypical forms of diabetes mellitus in Africans and other non-European ethnic populations in low- and middle-income countries: a systematic literature review

Abstract

BackgroundAtypical presentations of diabetes mellitus (DM) have been reported in non-European ethnic populations under various names. It is unclear whether those names are used for the same or different clinical phenotypes. Unclear terminology may lead to inappropriate treatment and an underestimation of the burden caused by atypical diabetes phenotypes overlapping with classic types of diabetes. This review aimed to describe the terms used for atypical forms of diabetes and to investigate whether the terms are used for similar or different phenotypes.MethodsPubMed and Scopus were searched for relevant publications in French or English available before 15 September 2015 using the terms: ”Atypical diabetes”, “Malnutrition Related Diabetes Mellitus (MRDM)”, “Fibro-calculus pancreatic diabetes (FCPD)”, Protein deficient Pancreatic Diabetes (PDPD)”, “African diabetes”, “Ketosis prone-type 2 diabetes”, “tropical diabetes”, “Flatbush diabetes”, “J-type diabetes”. Titles, abstracts screening and quality assessment were performed by two independent authors. Observational studies addressing atypical diabetes in humans aged 14 years and above were included. One author extracted data from selected articles.Results22 articles among 350 identified articles were retained for data extraction. Two atypical diabetes phenotypes were identified, each of them with a variety of names but similar definitions. One phenotype occurred in very thin people less than 30 years of age, typically from poor socio-economic backgrounds and requires insulin for life. It differs from type 1 diabetes in the tolerance of high blood glucose without ketosis in the absence of exogenous insulin. The second phenotype resembles type1 diabetes as it presents with ketosis at onset but responds well, as type2 diabetes, to oral hypoglycemic drugs after initial stabilization with insulin. It occurs in individuals who are usually over 30 years of age, with normal or overweight and absence of auto antibodies mainly found in type 1 diabetes.ConclusionThe scarce existing literature used various terms for similar diabetes phenotypes. Agreement on nomenclature for the various forms of diabetes using the above reported characteristics are needed in populations where atypical forms of diabetes exist as well as better characterization of phenotypes and genotypes to inform evidence based treatment.

Oral delivery of liraglutide-loaded Poly-N-(2-hydroxypropyl) methacrylamide/chitosan nanoparticles: Preparation, characterization, and pharmacokinetics

“…Compared with insulin dependence in the treatment of type 1 diabetes, the main cause of type 2 diabetes is insufficient insulin secretion, which is primarily related to obesity, lack of exercise, and excessive caloric intake, and can be treated by drugs such as insulin and glucagon-like peptide-1 (GLP-1) analogs. 5,6 GLP-1 analog therapy has emerged with the development of biotechnology. Liraglutide, one of these analogs, was approved by the US Food and Drug Administration in 2010 and is mainly used for the treatment of type 2 diabetes.…”

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

“…Furthermore, diabetes onset in Sub-Saharan Africa is reported to occur with more severe symptoms often in under-or normal weight individuals in comparison to Western populations [5]. There is limited information to support development of evidencebased guidelines for prevention, diagnosis, classi cation and management of potential atypical sub-type of diabetes mellitus in sub-Saharan Africa and other LMICs [6][7][8].…”

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

“…Furthermore, diabetes onset in Sub-Saharan Africa is reported to occur with more severe symptoms often in under-or normal weight individuals in comparison to Western populations [5]. There is limited information on socio-demographic, etiopathological and clinical pro le of diabetes to support development of context speci c guidelines for prevention, diagnosis, classi cation and management of potential atypical sub-types of diabetes mellitus in sub-Saharan Africa and other LMICs [6][7][8].…”