Is Tropical Pancreatic Diabetes Malnutrition Related?

Clinical syndromes of diabetes in tropical countries defy attempts to separate them into reasonably homogeneous groups that are analogous to the traditional classification into IDDM and NIDDM. Their geographical and clinical uniqueness has only been recognized relatively recently. For most of this century, diabetes in the tropics was thought to be no different from the classical form seen in more temperate climates, being found only in the well-nourished elite, but not in the malnourished masses (1). Thus, the WHO, in its first examination of the problem of diabetes from a world-wide perspective in 1965, stated emphatically that “the evidence that malnutrition protects populations from diabetes seems unassailable (2).” Notwithstanding this assertion, evidence had been accumulating for at least a decade that many diabetic individuals in the tropics had unusual features that made it impossible to pigeonhole them into either of the classic varieties of diabetes mellitus. From the earliest descriptions of the two syndromes of diabetes that have come to be recognized as being unique to the tropics (type J diabetes and TPD), the association of both syndromes with malnutrition was emphasized (3,4). Faced with the overwhelming evidence that diabetes did occur in malnourished individuals, WHO reversed its opinion in 1980, acknowledging that “in some societies … malnutrition is probably a major determinant (of diabetes) (5).”