Incidence of ‘protein deficiency diabetes mellitus’ found in Central India

NAGPUR: Clinicians are aware of Type 1 and Type 2 diabetes, but they are less familiar with tropical pancreatic diabetes, one of the forms of secondary diabetes mellitus (DM) not uncommon in India, claims a recent study by diabetologist Dr Sunil Gupta, Dr Kavita Gupta and Dr Sachin Gathe. The study was presented at a conference in Ahmedabad last week.

The paper highlights characteristics of alcoholic and non-alcoholic pancreatic DM. 32,900 records were selected for assessment from those registered at Dr Gupta's clinic. Of these, 31709 were Type 2 diabetes mellitus, 2003 were Type 1 diabetes, 2310 had gestational diabetes mellitus (high blood sugar that develops during pregnancy and usually disappears after delivery) and 585 patients had pancreatic diabetes.

Of the patients of pancreatic diabetes, data of 460 was compiled and alazyed for their characteristics and associated co-morbidities.

Secondary diabetes can be due to various causes including inflammation of pancreas (pancreatitis). Because of the damage to beta cells in pancreas, the process of insulin preparation ceases. "Two clinical forms of pancreatic diabetes are seen – one with history of alcoholism resulting from post-alcoholic chronic pancreatitis, with or without pancreatic calcification. The other non-alcoholic sub-group of pancreatic diabetes which was earlier classified as protein deficiency diabetes mellitus but was subsequently placed in the category of secondary DM. Such cases have been reported from Kerala, part of Orissa and then from Chennai," said Dr Gupta, adding they were found also in Central India.

There are two types of Insulin Resistant Diabetes Mellitus- alcohol and non-alcohol related, Dr Gupta said adding the study analyzed the two groups separately. Chronic alcoholism is a cause of pancreatic diabetes. For non-alcohol related, it is obesity, and protein deficiency diabetes mellitus (PDDM). Patients of PDDM typically have low BMI, poor-socio economic background, negative family history of diabetes, low C-Peptide and severe nonketotic hyperglycemia (Nonketotic hyperglycinemia (NKH) is an inherited condition in which the body is unable to breakdown and process some of the building blocks of protein).

"There is no history of alcoholism in such patients, typically those who work as farmers, labourers or rickshaw-drivers. They suddenly come to us with 400 or 600 blood sugar levels. Our data show such patients come 2-4 years too late to us, " said Dr Gupta adding that 75% of these patients remained untreated for 3-4 years.