13/08/2025
๐๐ซ๐จ๐ฉ๐ข๐๐๐ฅ ๐๐ข๐๐๐๐ญ๐๐ฌ (๐๐ฒ๐ฉ๐ ๐ ๐๐ข๐๐๐๐ญ๐๐ฌ)
1. ๐๐๐๐ข๐ง๐ข๐ญ๐ข๐จ๐ง & ๐๐๐จ๐ฉ๐
Tropical Diabetes is an umbrella term for unique diabetes phenotypes in tropical/subtropical regions, historically linked to malnutrition and exocrine pancreatic damage.
๐๐๐ฒ ๐๐จ๐ซ๐ฆ๐ฌ:
MRDM โ Malnutrition-Related Diabetes Mellitus.
FCPD โ Fibrocalculous Pancreatic Diabetes.
KPD โ Ketosis-Prone Diabetes.
2. ๐๐ข๐ฌ๐ญ๐ข๐ง๐๐ญ๐ข๐ฏ๐ ๐
๐๐๐ญ๐ฎ๐ซ๐๐ฌ
Ketosis resistance despite severe insulin deficiency (esp. MRDM, FCPD).
Associated with exocrine pancreatic insufficiency โ steatorrhea, malabsorption.
Cassava-derived cyanide exposure and vitamin A deficiency implicated in pathogenesis.
Increasing recognition of SPINK1 mutations and other genetic markers.
3. ๐๐ฎ๐๐ญ๐ฒ๐ฉ๐๐ฌ โ ๐๐ฅ๐ข๐ง๐ข๐๐๐ฅ ๐๐ฅ๐ฎ๐๐ฌ
๐๐๐๐
Young onset, low BMI, history of early-life malnutrition.
Severe insulinopenia, absent ketosis.
Exocrine insufficiency common.
Subtype: PDPD (Protein Deficient Pancreatic Diabetes) โ pancreatic atrophy from protein-energy malnutrition.
๐
๐๐๐
Chronic calcific non-alcoholic pancreatitis with pancreatic stones.
Lean patients, age ~23 years at presentation.
Insulin deficiency without ketoacidosis.
Diagnostic hallmark โ pancreatic calcifications on X-ray/USG.
๐๐๐
Acute DKA at onset, negative islet autoantibodies.
ฮฒ-cell function may recover โ possible insulin withdrawal.
Strong ethnic predisposition (African, Latino, South Asian).
4. ๐๐ข๐๐ ๐ง๐จ๐ฌ๐ข๐ฌ โ ๐๐๐ฒ ๐๐ข๐จ๐ฆ๐๐ซ๐ค๐๐ซ๐ฌ
C-peptide: Low/absent (MRDM, FCPD); variable recovery (KPD).
Autoantibodies: Negative in all tropical diabetes forms (differentiates from Type 1).
F***l elastase-1: Low in FCPD (exocrine insufficiency).
Emerging markers:
Adiponectin/leptin ratio โ lower than in T2DM.
IL-6, TNF-ฮฑ elevated in FCPD.
CRP higher in KPD.
5. ๐๐ฉ๐ข๐๐๐ฆ๐ข๐จ๐ฅ๐จ๐ ๐ฒ ๐๐ซ๐๐ง๐๐ฌ
MRDM declining in urban tropics with improved nutrition.
FCPD persists in rural cassava-consuming belts.
KPD rising with urbanisation and diet westernisation.
High prevalence in South Asia, Sub-Saharan Africa, Caribbean, parts of Latin America.
6. ๐๐ฎ๐๐ฅ๐ข๐ ๐๐๐๐ฅ๐ญ๐ก & ๐๐๐ง๐๐ ๐๐ฆ๐๐ง๐ญ ๐๐ก๐๐ฅ๐ฅ๐๐ง๐ ๐๐ฌ
Misclassification as Type 1 or Type 2 delays appropriate therapy.
Insulin affordability is a major barrier in LMICs.
Need for early screening in malnourished/recurrent pancreatitis cases.
Nutritional interventions โ reduce dietary cyanide, improve protein & micronutrient intake.
7. ๐๐ก๐๐ซ๐๐ฉ๐๐ฎ๐ญ๐ข๐ ๐๐๐๐ซ๐ฅ๐ฌ
FCPD & insulin-dependent MRDM โ pragmatic low-dose basal insulin + metformin/sulfonylurea may improve control & cost-effectiveness (needs RCT validation).
KPD โ intensive insulin during acute DKA, later possible transition to oral agents if ฮฒ-cell function recovers.
Tailor therapy using precision medicine principles considering metabolic & genetic profile.
8. ๐
๐ฎ๐ญ๐ฎ๐ซ๐ ๐๐ข๐ซ๐๐๐ญ๐ข๐จ๐ง๐ฌ
Consensus Type 5 Diabetes Guidelines expected from IDF Working Group (2027).
Push for biomarker-based classification and genetic screening (e.g., SPINK1).
Integration of public health policy to address nutrition, dietary toxins, and early-life health.
๐ก ๐๐๐ค๐-๐ก๐จ๐ฆ๐
In the tropics, not all โType 2-lookingโ diabetes is Type 2. Think Tropical Diabetes in lean young adults with malnutrition history, pancreatic calcification, ketosis resistance, or reversible DKA. Early recognition can prevent years of mismanagement.
