New Delhi: Type 2 diabetes is often associated with people who are overweight and obese. However, recent research has shown that the disease takes two shapes depending on the patient’s body mass.
In people with a high Body Mass Index (BMI), type 2 diabetes is driven by insulin resistance — when cells in muscles, fat, and the liver do not respond well to insulin. However, in patients with a lower BMI, type 2 diabetes is the result of a pancreas that fails to produce enough insulin.
The study was published in Diabetologia by researchers at the Amsterdam University Medical Centre and the University of Ghana.
“We concluded that lean patients often develop eye damage, known as retinopathy, and strokes. People who are overweight, by contrast, more often have high blood pressure and an increased risk of cardiovascular disease. Chronic kidney disease occurred equally often in both groups,” senior author Felix Chilunga said in a press release.
Despite there being two different reasons for type 2 diabetes, the treatment and medication for the disease is the same. In wealthy countries, diabetes is mostly associated with obesity and nearly nine out of 10 people with type 2 diabetes are overweight. But the study found that nearly four in 10 African adults with type 2 diabetes were lean.
One of the study’s first authors, Sabrina Esmail said that this means there are nearly 1 crore lean patients in the African continent for whom their illness is a “a shortage of insulin, not a reduced response to insulin”. Most of these patients are being given medication based on “international guidelines” but they are being treated for insulin resistance. So far, the consequences of such wrong treatment have not even been investigated, said a university press release.
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Treating the wrong illness
To study the difference, researchers analysed data from over 3,300 African adults with type 2 diabetes. Many of them had experienced malnutrition or a lower weight at birth which disrupted the development of their pancreas.
“African patients in Europe have a lower BMI but are treated according to guidelines written for the form of the disease found in people who are overweight, and their control is demonstrably worse. There is no reason to assume that the treatment mismatch we describe stops at the border,” said project leader Charles Agyemand at Amsterdam University Medical Center in a press release. He highlighted the need for conducting more clinical trials and finding more suitable treatment.
His recommendation comes at a time where studies of migrants in Europe have shown that Africans are likely to develop type 2 diabetes 10 years earlier than European populations. They have also shown poorer control over blood sugar.