Albert Einstein College of Medicine, Bronx, NY.
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, Vellore, India.
Diabetes Care. 2022 Jun 2;45(6):1428-1437. doi: 10.2337/dc21-1957.
Diabetes among individuals with low BMI (<19 kg/m2) has been recognized for >60 years as a prevalent entity in low- and middle-income countries (LMICs) and was formally classified as "malnutrition-related diabetes mellitus" by the World Health Organization (WHO) in 1985. Since the WHO withdrew this category in 1999, our objective was to define the metabolic characteristics of these individuals to establish that this is a distinct form of diabetes.
State-of-the-art metabolic studies were used to characterize Indian individuals with "low BMI diabetes" (LD) in whom all known forms of diabetes were excluded by immunogenetic analysis. They were compared with demographically matched groups: a group with type 1 diabetes (T1D), a group with type 2 diabetes (T2D), and a group without diabetes. Insulin secretion was assessed by C-peptide deconvolution. Hepatic and peripheral insulin sensitivity were analyzed with stepped hyperinsulinemic-euglycemic pancreatic clamp studies. Hepatic and myocellular lipid contents were assessed with 1H-nuclear magnetic resonance spectroscopy.
The total insulin secretory response was lower in the LD group in comparison with the lean group without diabetes and the T2D group. Endogenous glucose production was significantly lower in the LD group than the T2D group (mean ± SEM 0.50 ± 0.1 vs. 0.84 ± 0.1 mg/kg · min, respectively; P < 0.05). Glucose uptake was significantly higher in the LD group in comparison with the T2D group (10.1 ± 0.7 vs. 4.2 ± 0.5 mg/kg · min; P < 0.001). Visceral adipose tissue and hepatocellular lipids were significantly lower in LD than in T2D.
These studies are the first to demonstrate that LD individuals in LMICs have a unique metabolic profile, suggesting that this is a distinct entity that warrants further investigation.
BMI（<19kg/m2）较低的个体中存在糖尿病，这一现象在过去 60 多年里已在中低收入国家（LMICs）得到证实，1985 年世界卫生组织（WHO）正式将其归类为“与营养不良相关的糖尿病”。自 1999 年 WHO 取消该分类后，我们的目标是确定这些个体的代谢特征，以证实这是一种独特的糖尿病形式。
采用最先进的代谢研究方法来描述印度“低 BMI 糖尿病”（LD）个体，这些个体通过免疫遗传学分析排除了所有已知类型的糖尿病。他们与在人口统计学上相匹配的三组进行比较：一组患有 1 型糖尿病（T1D），一组患有 2 型糖尿病（T2D），一组无糖尿病。通过 C 肽反卷积评估胰岛素分泌。通过逐步高胰岛素-正常血糖钳夹研究分析肝和外周胰岛素敏感性。使用 1H 核磁共振波谱法评估肝和肌细胞内脂质含量。
与无糖尿病的瘦个体和 T2D 组相比，LD 组的总胰岛素分泌反应较低。与 T2D 组相比，LD 组的内源性葡萄糖生成明显较低（平均值±SEM 分别为 0.50±0.1 和 0.84±0.1mg/kg·min；P<0.05）。与 T2D 组相比，LD 组的葡萄糖摄取明显更高（10.1±0.7 与 4.2±0.5mg/kg·min；P<0.001）。LD 组的内脏脂肪组织和肝细胞内脂质明显低于 T2D 组。
这些研究首次表明，中低收入国家的 LD 个体具有独特的代谢特征，表明这是一种独特的实体，值得进一步研究。
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