Malnutrition related Diabetes an ignored entity.pptx

Malnutrition related Diabetes Type5 DM

1. MALNUTRITION RELATED DIABETES-AN IGNORED ENTITY DR TARAK NATH CHATTOPADHYAY MBBS MD GENERAL MEDICINE ( GOLD MEDALIST) CCEBDM CONSULTANT PHYSICICIAN & DNB FACULTY HEALTH WORLD HOSPITAL DURGAPUR

2. Introduction In a major step forward, the International Diabetes Federation (IDF) has officially recognized Type 5 diabetes—also known as malnutrition-related diabetes—as a distinct form of the disease. This condition, which primarily affects lean, undernourished teens and young adults in low- and middle-income countries, has long been misunderstood and misclassified under the more commonly known types: Type 1 or Type 2. Type 5 diabetes is distinct from type 1 and type 2 diabetes due to its unique causes, symptoms, and treatment approaches.

3. Type 5 Diabetes: A new face of Dysglycemia…. Subcategory of T2DM??? T1DM?? Different immunogenecity Unique form of diabetes??

4. Type 5 Diabetes Type 5 diabetes is a unique form of diabetes seen mainly in people who have experienced long-term undernutrition, especially during their early years of life. It’s been around for decades—particularly in parts of Asia and Africa—but has often been misdiagnosed or overlooked. Unlike Type 2 diabetes, which is linked to obesity and insulin resistance, Type 5 diabetes results from a poorly developed pancreas. Why? Because of chronic malnutrition in childhood. The pancreas doesn’t produce enough insulin—not because of autoimmune destruction like in Type 1, and not due to insulin resistance like in Type 2. That’s what makes this condition so unique and different.

5. The History and Recognition of Type 5 Diabetes

6. PATHOPHYSIOLOGY

7. Fetal and early life undernutrition; Low total calories, carbohydrate, fat, protein, micronutrient deficiency Oxidative stress due to micronutrient deficiency Dysfunction of pancreatic transcription factors Moderate to Severe Dysglycemia Lysine deficiency  Carnitine deficiency KETOSIS RESISTANT Low stimulators of B cell proliferation Eg:Glucose Toxin ingestion Eg : Cassava Epigenetic modifications High counterregulatory hormones- Growth hormone, glucagon, cortisol etc. Absence of pancreatic calcification Evidence of chronic malnutrition Low beta cell reserve Insulin deficiency

8. Developmental trajectory showing how early life malnutrition leads to metabolic alterations and ultimately type 5 diabetes in young adulthood. 

9. Phenotypic characteristics Type 5 Diabetes Type 1 diabetes Pancreatic Diabetes/ FCPD Type 2 Diabetes Age of onset 3 rd decade/ early adulthood <18 years 3 rd decade and above 4rth decade and above Family history Weak Moderate Weak Strong History of childhood malnutrition Strong Absent May be present Absent BMI (kg/m2) Low(<18.5 kg/m2) Lean(18.5-24.9 kg/m2) Lean Overweight or Obese Ketonuria without insulin Absent Present, with precipitating event Absent Absent Beta cell function Impaired + Impaired ++, Impaired + Preserved with progressive decline Insulin sensitivity ++ ++ ++ + Response to OADs May be partially + Absent +/- Responsive to OADs Pancreatic imaging Normal Normal Calcification, ductal dilatation Normal Hepatic and pancreatic steatosis Negative Negative Negative Positive

10. Causes and Risk Factors of Type 5 Diabetes

11. Symptoms of Type 5 Diabetes: Type 5 diabetes presents unique symptoms that can be mistaken for type 1 or type 2 diabetes. Common signs include: High blood glucose levels without ketoacidosis (unlike type 1). Extreme thirst and frequent urination. Unexplained weight loss despite normal or increased appetite. Fatigue and weakness due to malnutrition. Slow-healing wounds or frequent infections. Because symptoms overlap with other diabetes types, misdiagnosis is common, especially in resource-limited settings.

12. Diagnosis: Diagnosing type 5 diabetes requires a combination of clinical and laboratory assessments: Blood Tests: Elevated fasting blood glucose (>126 mg/dL) or HbA1c (>6.5%) without ketosis. Immunogenetic Analysis: Absence of autoimmune markers (e.g., GAD antibodies) rules out type 1 diabetes. Nutritional Assessment: Low BMI, protein deficiency, or micronutrient imbalances support a type 5 diagnosis. Clinical History: History of malnutrition or residence in high-risk regions.

13. Diagnostic algorithm for type  5 diabetes

14. TREATMENT

15. Group A: Candidates for oral medication

16. Group B: Requires insulin therapy Patient profile C-peptide >0.5 ng/mL (after stimulation) Severe hyperglycemia (HbA1c >10%) Long-standing diabetes (>5 years) Failed oral medication trial.

17. Group C: Combination therapy

18. Nutritional support

19. Conclusion The official recognition of type  5 diabetes represents a significant advancement in understanding the diverse spectrum of diabetes. This distinct form, affecting an estimated 20–25 million people worldwide, is characterized by insulin secretory defects rather than insulin resistance, and has strong associations with early-life malnutrition. Its unique pathophysiological profile has important implications for treatment approaches, suggesting some patients may be managed with oral medications rather than insulin. As diabetes prevalence continues to rise globally, particularly in LMICs, recognizing and appropriately managing type  5 diabetes become increasingly crucial.

20. Thank You