New diabetes type impacts youth

Published Jun 9, 2024


Durban — A new classification of diabetes, officially recognised by the World Health Organization (WHO), has become a cause for concern among medical professionals because of its manifestation and impact on children, teenagers and young adults.

And it is prevalent in young patients who are obese or overweight, resulting in diabetic complications and death in the prime of their lives.

The WHO officially recognised “hybrid diabetes” in 2019.

Dr Imran Paruk, an endocrinologist in the Department of Diabetes and Endocrinology at the University of KwaZulu-Natal and Inkosi Albert Luthuli Hospital, spoke at a webinar about hybrid diabetes initiated by the UKZN’s School of Clinical Medicine’s “extension for community healthcare outcome” (ECHO) outreach project.

Paruk said more patients were diagnosed with hybrid diabetes when a higher index of suspicion is applied, and improved investigations, which include more diagnostic tests.

“For decades, medical schools taught that there are two types of diabetes mellitus … this is no longer the case,” Paruk said.

Type 1 and Type 2 diabetes were the well-known forms of the disease. Typically, Type 1 occurs among juvenile patients with normal weights; their pancreas produces little or no insulin. Therefore, they are insulin-dependent. Type 2 diabetes occurs in adults who are not physically active, overweight or obese, and their bodies don’t produce enough insulin, or it resists insulin.

“In the past we considered a patient’s age and appearance. If they were young and not obese or overweight, they were Type 1 and prescribed insulin treatment.”

When consulting older patients who were overweight and obese, Paruk said they were diagnosed as Type 2 patients and were put on tablets.

“Recently, we noticed an overlap between Type 1 and 2 diabetes. Young individuals presented with features of Type 1 diabetes, but were overweight or obese. On the other hand, we would never think that a young child, adolescent or young adult would be Type 2 patients; we are seeing that as well.”

Paruk said there were two types of diabetes under the hybrid banner: Lada (latent autoimmune diabetes of the adult) and ketosis-prone Type 2 diabetes. Creating hybrid diabetes awareness, especially among doctors, was key.

“The message to doctors is the need for a higher index of suspicion where a patient with diabetes has some features that are not typical. They must be referred to an endocrinologist.”

Paruk said diabetes was rife in South Africa, with nearly half the population overweight or obese.

“The strange thing about the youth onset Type 2 diabetes was that they progress more quickly towards complications and end up having a higher mortality and earlier mortality.

“The complications in adults may occur maybe 15 to 20 years after diagnosis; with youth it could be after a decade.”

He said research showed that obesity was much less common in the 20th century.

“It’s not genetics that changed, but the environment. We are more exposed to processed food, sugar-sweetened beverages and not living an active lifestyle.”

Paruk said diabetes can be beaten through disciplined effort that supported lifestyle changes (diet, exercise and rest), new drugs that are available and bariatric surgery (that which involves making changes to the digestive system to promote weight loss).

Maria van der Merwe, dietician and president of the Association for Dietetics in South Africa, said previously the belief was that energy consumed through food must be expended through physical activity to maintain weight levels.

“That’s what happens physiologically, but we need to consider the contextual and structural factors that impact on what we eat and the energy we consume.”

Van der Merwe said the underlying obesity contributors were hormonal components, familial history, psycho-social components, mental health and the food environment.

The “food environment” referred to what food people had access to, what was affordable, family preferences and cultural norms, she said.

Sunday Tribune