Nutrition plays a crucial role in the effective management of diabetes. A well-balanced diet is essential for maintaining stable blood sugar levels and preventing associated complications. The significance of nutrition in managing rare forms of diabetes was further highlighted by Dr Nihal Thomas, senior professor of endocrinology, department of endocrinology, diabetes and metabolism, Christian Medical College Hospital, Vellore.
While speaking at ‘The Edge of Nutrition Summit’ organised by Happiest Health on July 11 and 12, 2023, he shed light on how malnutrition can also be a contributing factor for several rare forms of diabetes. According to him, rare conditions like protein-deficient diabetes (a form of secondary diabetes mellitus) and fibrocalculous pancreatic diabetes (a form of diabetes associated with both endocrine and exocrine conditions of the pancreas) are more common in tropical regions. Citing an example, he said that while fibrocalculous pancreatic diabetes (FCPD) was prevalent in Kerala earlier, the cases have reduced now, probably due to a change in diet and lifestyle. He recalled the case of a 33-year-old man with FCPD who presented with severe abdominal pain, oily stool, diarrhea and massive weight loss over three years. A CT scan revealed that his pancreas had shrunk and contained several calcium stones; he had to be put on enzyme supplements to regain weight.
Dr Thomas, who’s also a researcher, further emphasised that conditions like FCPD can often be misdiagnosed as diabetes mellitus. Hence, it’s very important to do a complete workup that includes a detailed family history along with measuring insulin capacity, C-peptide levels and antibody levels to rule out any possibility of type 1 diabetes.
Dr Thomas also spoke about MODY (maturity-onset diabetes of the young), a rare form of diabetes caused by a genetic mutation that can be passed down through generations in the families affected by it. There are different MODY mutations as well. He shared case studies of an eight-year-old girl with MODY-2 and a 16-year-old girl with MODY-5, where the diagnoses were made via genetic testing as the antibody tests were negative.
Diabetes is usually more common in people with obesity. However, some rare forms can also develop in lean women who are pregnant. Speaking about it, Dr Thomas said that despite having a normal BMI (body mass index), lean women can also develop diabetes during the first trimester. “Tests revealed that these women carried a genetic mutation, which can help experts with the early identification of these rare forms of diabetes in the next generation,” he said, elaborating on the cases he came across.
According to Dr Thomas, social inequity and historical events also have an impact on health. “Factors like wars, famines and colonisation contributed in part to the health issues, as they affected the education system and socio-economic status, leading to reduced participation of women in decision-making in the past,” he said.
