Tropical or Malnutrition-Related Diabetes: A Real Syndrome?

A, Abu-Bakare; Gill, Geoffrey; Taylor, Robert W.; Alberti, K. G. M. M.

doi:10.1016/s0140-6736(86)91846-5

Cited by 121 publications

(75 citation statements)

References 36 publications

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“…The scenario in northern Ethiopia is certainly compatible with the existence of malnutrition-related diabetes mellitus, since serious famines occurred here in the mid1980s (when most of our insulin-treated patients were children) and food shortages have continued since. Moreover, malnutrition-related diabetes mellitus has been described previously in Ethiopia [29] and, interestingly, a male excess, usually around a 2:1 ratio, is well described in the syndrome [3,9,24]. Due to male excess, low BMI, early onset, past (and often present) malnutrition, plus insulin requirement but not dependence, many of our insulin-treated patients fulfil current criteria for malnutrition-related diabetes mellitus.…”

Section: Discussionmentioning

confidence: 75%

“…Of the two described subgroups of malnutrition-related diabetes mellitus, i.e. fibrocalculous pancreatic diabetes and malnutrition-modulated diabetes mellitus [24], the latter would fit best with our patients. Although we did not perform abdominal x-rays or ultrasounds as part of our research protocol, pancreatic calcification is not seen in the Mekelle area and none of our patients had steatorrhoea.…”

Section: Discussionmentioning

confidence: 77%

“…We and others have surmised that because of these clinical observations and the marked past and present undernutrition in the area, these patients may have malnutrition-related diabetes mellitus [9,13,24]. The present study measured GADA and IA-2A to internationally accepted specifications [17][18][19], as well as fasting C-peptide.…”

Section: Discussionmentioning

confidence: 85%

“…One distinct possibility is that our insulin-treated patients may have malnutrition-related diabetes [2,3,24]. This entity has been described for many decades and is based on the hypothesis that malnutrition in early life leads to pancreatic beta cell damage with varying degrees of insulin hyposecretion.…”

Section: Discussionmentioning

confidence: 99%

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Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition

et al. 2010

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Aims/hypothesis Surveys in northern Ethiopia have demonstrated that apparent type 1 diabetes occurs more frequently than elsewhere in Africa and, indeed, in other parts of the world. We therefore investigated in detail a cohort of diabetic patients from this region to clarify the nature of this type of diabetes. Methods All patients attending the diabetic clinic at Mekelle Hospital in the Tigray region of northern Ethiopia were investigated over a 6 week period. Clinical, demographic and anthropometric data were collected, as well as measurements of HbA 1c , fasting lipid profile, fasting serum Cpeptide and serum markers of beta cell autoimmunity, i.e. islet antigen-2 and GAD antibodies (GADA). Results Of 105 patients seen, 69 (66%) were on insulin treatment and had been from or close to diagnosis. Their median age and diabetes duration were 30 and 5 years, respectively, with a male excess of 2:1. Median BMI was 20.6 kg/m 2 . Despite these clinical characteristics suggestive of type 1 diabetes, only 42 of 69 (61%) patients were Cpeptide-negative and 35% GADA-positive. Overall, 38 (36%) of the total group (n=105) had immunological or C-peptide characteristics inconsistent with typical type 1 or type 2 diabetes. The clinical characteristics, local prevalence of undernutrition, and GADA and C-peptide heterogeneity suggest a malnutrition-related form of diabetes. Conclusions/interpretation Not all patients in northern Ethiopia with apparent type 1 diabetes appear to have the form of disease seen in Europids; their disease may, in fact, be related to malnutrition.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition

et al. 2010

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“…Malnutrition related diabetes mellitus (MRDM) is a rare cause of diabetes confined to countries in the tropical belt [1]. The World Health Organisation study group on diabetes has recommended its classification into two sub-types, namely protein deficient pancreatic diabetes (PDPD) and fibrocalculous pancreatic diabetes (FCPD) [2].…”

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confidence: 99%

The genetic predisposition to fibrocalculous pancreatic diabetes

et al. 1989

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Summary. Fibrocalculous pancreatic diabetes (previously known as tropical pancreatic diabetes) is a rare cause of diabetes confined to countries within the tropical belt. The aetiology of fibrocalculous pancreatic diabetes is thought to be environmental although the agent(s) is unknown. We have investigated a possible genetic basis of this disease by looking for restriction fragment length polymorphisms of genes implicated in the aetiology of diabetes rnellitus. Seventy-six Dravidian patients with fibrocalculous pancreatic diabetes were studied, and the restriction fragment length polymorphisms obtained compared to racially matched control subjects (n=94), patients with Type2 (non-insulin-dependent) diabetes (n=87) and Type 1 (insulin-dependent) diabetes (n = 58). No association of fibrocalculous pancreatic diabetes was found with restriction fragment length polymorphisms of the insulin receptor gene. Although no association of fibrocalculous pancreatic diabetes was found with polymorphism of the HLA DRc~/DQc~/DXct genes, an association was found with the Taq 1 restriction fragment length polymorphisms of the DQ[~ gene (DQ[~ T2/T6 present in 39% of patients with fibrocalculous pancreatic diabetes compared to 19% in control subjects; p = 0.01 ; corrected p value = 0.04) which is similar to that found in Type 1 but not Type 2 diabetes. An association of fibrocalculous pancreatic diabetes was also found with the hypervariable region in the 5-prime flanking region of the insulin gene; 40% of patients possessed the class 3 allele compared to 9.5% of control subjects p = 0.0001 ; corrected p value = 0.0008). In Type 2 diabetes, similar results were obtained with 33% subjects possessing the class 3 allele (t7 value compared to control subjects = 0.0005; corrected p value = 0.004). This study suggests that fibrocalculous pancreatic diabetes has a genetic component in its aetiology. Furthermore, its origin might be related to an individual with part of the genetic predisposition to diabetes (Type 1 or Type 2) who additionally has evidence of chronic calcific pancreatitis.

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Overview and Consensus Statement on Diabetes in Tropical Areas

Samal

1997

Diabetes Metab. Rev.

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Tropical or Malnutrition-Related Diabetes: A Real Syndrome?

Cited by 121 publications

References 36 publications

Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition

Immunological and C-peptide studies of patients with diabetes in northern Ethiopia: existence of an unusual subgroup possibly related to malnutrition

The genetic predisposition to fibrocalculous pancreatic diabetes

Overview and Consensus Statement on Diabetes in Tropical Areas

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