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07-04-2018 | Type 2 diabetes | Review | Article

Diabetes Among Non-Overweight Individuals: an Emerging Public Health Challenge

Journal: Current Diabetes Reports

Authors: Unjali P. Gujral, Mary Beth Weber, Lisa R. Staimez, K. M. Venkat Narayan

Abstract

Purpose of Review

Overweight and obesity are well-established risk factors for type 2 diabetes. However, a substantial number of individuals develop the disease at underweight or normal weight. In this review, we discuss the epidemiology of type 2 diabetes in non-overweight adults; pose questions about etiology, pathophysiology, diagnosis, and prognosis; and examine implications for prevention and treatment.

Recent Findings

In population-based studies, the prevalence of type 2 diabetes ranged from 1.4–10.9%. However, the prevalence of type 2 diabetes in individuals with BMI < 25 kg/m² ranged from 1.4–8.8%. In countries from Asia and Africa, the proportion of individuals with diabetes who were underweight or normal weight ranged from 24 to 66%, which is considerably higher than the US proportion of 10%. Impairments in insulin secretion, in utero undernutrition, and epigenetic alterations to the genome may play a role in diabetes development in this subgroup.

Summary

A substantial number of individuals with type 2 diabetes, particularly those with recent ancestry from Asia or Africa, are underweight or normal weight. Future research should consist of comprehensive studies of the prevalence of type 2 diabetes in non-overweight individuals; studies aimed at understanding gaps in the mechanisms, etiology, and pathophysiology of diabetes development in underweight or normal weight individuals; and trials assessing the effectiveness of interventions in this population.

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