Diabetes is often associated with obesity, but research reveals that even those at a healthy weight can develop the condition, a phenomenon known as lean diabetes. Studies indicate that a significant portion of Type 2 diabetes patients—52.56% of men and 43.57% of women—experience this condition despite maintaining a normal body weight.
What Triggers Lean Diabetes?
Lean diabetes occurs in individuals with a body mass index (BMI) under 25 but with blood glucose levels above 200, necessitating diabetic medication. While the precise causes are multifaceted, studies from institutions like CMC Vellore identify several contributing factors. These include primary pancreatic disorders, genetic predispositions affecting insulin production and resistance, malnutrition, and low birth weight. According to Dr. Nihal Thomas, senior professor at CMC Vellore, diabetes is increasingly understood as a complex condition that can arise through various mechanisms, including poor nutrition, even in those who are underweight.
Complications of Lean Diabetes
Interestingly, lean diabetes can lead to more severe complications than the form of diabetes associated with obesity. These complications include neuropathy (nerve damage), retinopathy (damage to the retina), and nephropathy (kidney damage). Additionally, lean diabetics may develop these issues at a younger age, with men being more frequently affected. Factors like smoking and alcohol use are also linked to a higher prevalence of lean diabetes.
Another form of lean diabetes, particularly in tropical regions, is fibrocalcific pancreatic diabetes, which is characterized by a shrunken pancreas and difficulty absorbing fats. This under-recognized condition requires not only insulin therapy but also enzyme supplementation to aid fat absorption. Similarly, Maturity Onset Diabetes of the Young (MODY), an inherited form of diabetes, can also cause lean individuals to develop insulin resistance, with some requiring large doses of insulin due to the inefficacy of smaller doses.
The Growing Importance of Understanding Lean Diabetes
Recent research sheds light on the prevalence of lean diabetes, especially in South Asia. A study using data from the National Family Health Survey (NFHS-5) found that 8.2% of men and 6% of women had elevated blood glucose levels, with 2.9% of men and 2.4% of women diagnosed with lean diabetes. Among those with Type 2 diabetes, a substantial percentage—52.56% of men and 43.57% of women—had lean diabetes. Interestingly, lean diabetes was more common in lower-income groups, with the prevalence reaching 11.6% in the poorest quintile.
The rise of diabetes in South Asia has been a topic of concern, with predictions suggesting that its prevalence could increase by 68% by 2050. Dr. Thomas, who contributed to a Lancet study on the subject, highlights the importance of recognizing diabetes subtypes, including those triggered by malnutrition or genetic factors, rather than simply classifying it as Type 1 or Type 2.
Global Insights on Lean Diabetes
Global studies, including one conducted in Sub-Saharan Africa, further emphasize the complexity of lean diabetes. Dr. Thomas’ study showed that 11.3% of underweight individuals with non-obese, new-onset Type 2 diabetes suffered from insulin deficiency, a condition not seen in those with normal weight.
As awareness of lean diabetes grows, it becomes increasingly clear that the condition cannot be explained solely by obesity. With factors like genetics, nutrition, and other medical conditions playing significant roles, understanding and managing lean diabetes is crucial for tackling the global diabetes epidemic.
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