People with DM5 produce less insulin than type 2 diabetes, but in greater quantities than people with type 1 diabetes. On the other hand, insulin sensitivity is kept in DM5. This shows that DM5 is not only a variant, but a metabolic condition linked to malnutrition
_The Brazil Conversation and Cadernos Public Health Magazine/Reports in Public Health (CSP) have collaborated to bring unpublished articles on scientific studies, original research and critical reviews in various areas of public health. The CSP magazine has been published since 1985 with the support of the Sergio Arouca National School of Public Health (ENSP/Fiocruz) and brings together scientific articles aimed at the production of knowledge in the field of collective health and related disciplines. This article explores the relationship between food insecurity and diabetes associated with malnutrition.
The predominant opinion that associates the emergence of diabetes only with overweight and calories neglect another relevant factor: the chronic deprivation of food. It is precisely in this scenario that diabetes relating to malnutrition, DM5 (type 5 diabetes mellitus) stands, in which prolonged hunger plays a central role in the genesis of the disease.
To understand this picture, the researchers of the Global Diabetes Institute at the Albert Einstein College of Medicine in Bronx, New York (USA), studied the metabolic and genetic profile of people with this type of diabetes. The researchers have shown that DM5 patients do not have self -anti -anti or mutations typical of monogenic (and rarer) forms of diabetes.
In addition, people with DM5 produce less insulin than type 2 diabetes, but more than people with type 1 diabetes. On the other hand, insulin sensitivity is kept in DM5. These results reveal that this type of diabetes is not only a variant of known forms, but a distinct metabolic condition, closely linked to chronic malnutrition.
Serious metabolic conditions related to hunger
The severe food insecurity is defined by the organization for agriculture and the United Nations food (FAO/UN) as the recurring lack of access to sufficient food, leading people to spend a day or more without eating. It is, in practice, the violation of human law to adequate food. In Brazil, this condition is mainly measured by the Brazilian food insecurity scale (Ebia), which classifies families in slight, moderate or severe food safety or food insecurity.
Described for the first time in 1955, in Jamaica, the diabetes associated with malnutrition was subsequently documented in various countries of sub -Saharan Africa and Asia. In India, he even represented about 23% of cases of illness. In 1985, the World Health Organization also included this presentation as Diabetes Mellito attached to malnutrition, but removed the classification years later due to the lack of robust studies.
The scientific interest has grown again with the research that clarified the mechanisms with which the hunger exhibition during pregnancy and childhood has increased the risk of metabolic and cardiovascular diseases in adulthood. The epidemiologist David Barker was one of the former, in this area, when he showed The relationship between low birth weight and greater risk of heart disease. Subsequently, Barker showed the relationship with glucose intolerance, type 2 diabetes, hypertension and cholesterol changes.
This scenario can be even more worrying in the countries of Latin America, in which obesity and nutritional needs often coexist in the same family – or even in the same person -, a phenomenon called double load of poor nutrition. In Brazil, the data of the longitudinal health study of the Brazilian elderly (Elsi-Brazil) showed that a quarter of 50 years of people spent hunger during childhood, especially in the North and North-East. These people had 20% more possibilities to develop diabetes in adulthood. This suggests that the history of food insurgent can be connected to the diagnosticated diabetes today.
The incidence in medium and low income countries
The clinical characteristics overlapping with type 1 – like the first need for insulin – can lead to incorrect diagnosis, especially in countries where serious hunger was frequent. This raises the question: in low and medium income countries, how many cases of diabetes would not actually be DM5?
IDF estimates that between 20 and 25 million people in the world will be affected by the DM5. In Brazil, although there are no specific estimates for this subtype, it is estimated that 16.6 million live with diabetes, a number that could reach 24 million by 2050. At the same time, 33 million have faced hunger and 15.5% of families lived in serious food insecurity in the postpandic period. These data show the coexistence of two crises: the progress of diabetes and the persistence of food insycitude, strengthening the need for integrated public policies, which alienating prevention, health care and guarantee of human law to adequate food.
The inclusion of DM5 on the international agenda also brings the challenge of integrating social data with the diagnoses of chronic diseases. Today, these diagnoses are mainly based on clinical and laboratory tests, often not incorporating the history of the patient’s life. Including variables such as the relationship of childhood hunger or the short stature can help identify risk groups. In Brazil, tools such as the risk of food insecurity (Tria), a rapid questionnaire of two articles incorporated into the health information system for primary care (Sisab), can accelerate the screening of vulnerable families.
The recognition of DM5 can also influence public policies aimed at pregnancy and early childhood. Bad maternal nutrition compromises fetal development and increases metabolic vulnerability for life (6,20,21). Guaranteeing food safety in these critical periods can prevent immediate malnutrition not only, but also its long -term consequences, such as the emergence of atypical forms of diabetes.
In proposing that the diagnostic formulation considers social dimensions as an inseparable part of the disease process, the recognition of diabetes related to malnutrition represents a breakage of the paradigm in understanding endocrynometabolic diseases. In addition to the medical debate, this IDF decision is also a political milestone: he is hungry at the center of the discussion in diabetes and strengthens the fact that fighting food insecurity is an essential strategy of public health.
The author received a doctoral scholarship from coordinating the improvement of higher education staff (Capes) and institutional support of the National Institute of Science and Technology who fights hunger (hunger for inct),
Prof. Dr. Dirce Marchioni was councilor of the thesis of the author of the author Daniel Ferreira. She is a coordinator of the National Institute of Science and Technology (INCT) Fighting Hunger (Ince Hunger Fight).
Source: Terra
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