Several points of difference can be made between features of diabetics of the Western world and the tropical countries. In addition to a lower incidence of juvenile diabetes and diabetic coma in the tropics there is a high incidence of marked underweight among diabetics of the older age group as well as the young.
Observations on ninety-six patients at Cuttack, India, reveal that apart from a few cases of juvenile diabetes and a moderate number of elderly-obese patients there is a high incidence of atypical cases. Some of these are young and very lean but require large doses of insulin for control and are not prone to ketosis (“J”) type. Others are middle-aged and generally responsive to sulfonylurea compounds but are very lean even at onset of disease (elderly-lean type).
Division of the patients into two groups, one seen in the hospital wards and the other in the private clinics (domiciliary), makes it apparent that the unusual types of diabetics are for the most part the poorer hospital (ward) patients. Of these 39.8 per cent are “J” type and 43.7 per cent are elderly-lean types compared with zero and 4.9 per cent, respectively, in the domiciliary group.
The hospital patients have been subject to chronic undernutrition and most of them take large carbohydrate meals at long intervals, often only one a day. It is postulated that imposition of this dual stress of intermittent starvation and overload on carbohydrate metabolism may be related to the atypical patterns of clinical diabetes.