Understanding Atypical Diabetes and Diabetes in the Youth

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There is an alarming increase in what health experts have coined “atypical diabetes” as well as diabetes in the youth due to factors such as obesity which have not been very common in recent decades, says Inkosi Albert Luthuli Central Hospital specialist consultant Dr Imran Paruk.

Paruk adds that meta-analysis over the past 30 years has confirmed that there is more to diabetes than the commonly known type 1 diabetes, which was previously called juvenile diabetes, and then type 2 diabetes (T2DM), known as non-insulin-dependent diabetes.

Said Paruk: ‘For decades, medical schools taught that there are two types of diabetes mellitus… this is no longer the case.’

Paruk was speaking during a webinar held as part of UKZN’s Extension for Community Healthcare Outcome (ECHO)-Outreach Project, which falls under the School of Clinical Medicine’s Department of Diabetes and Endocrinology. Unique cases were presented where age and obesity did not correlate with the standard classification of either type 1 (T1DM) or type 2 diabetes (T2DM). Due to such observations, the World Health Organization updated its Classification of Diabetes in 2019.

‘What people need to know about T2DM in Youth is that the incidence is increasing globally and the main driver is obesity but other factors include genetics, epigenetics and social determinants such as lower socio-economic status,’ he said. ‘This category of patients has more rapid and progressive beta-cell decline compared to adults and they are also at higher risk for accelerated development of complications, early morbidity and mortality.’

Paruk said it took a multidisciplinary care team including primary care physicians, endocrinologists, dietitians, diabetes nurse educators, psychologists, social workers as well as efforts by the patients themselves to actively manage T2DM in youth. Treatment options were limited with metformin and/or insulin therapy being the mainstay of therapy. Innovative approaches to prevention and treatment were needed. Newer agents like SGLT inhibitors (a class of prescription medicines that are FDA-approved for use with diet and exercise to lower blood sugar in adults with type 2 diabetes) and GLP-1 analogues (a type of medication works by increasing the levels of hormones called “incretins”) were exciting agents that still required more evidence in this category of patients.

Paruk advised that lifestyle modification was key. ‘Excess weight must be lost; processed foods, fast food, saturated fats and sweetened beverages must be eliminated from the diet; a decrease in sedentary behaviour and increased physical activity is paramount. There should be more education around insulin therapy while pharmacotherapy for weight reduction in the youth must be prioritised.’

His presentation was well-received by ECHO participants, both locally and internationally.

Words: Lunga Memela

Photograph: Supplied