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Albert
Einstein College of Medicine – CMC Vellore Collaboration |
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CMC
Vellore is establishing collaborative research projects
with the Albert Einstein College of Medicine Global
Diabetes Initiative to investigate the pathogenesis
and management of an elusive condition referred to as
'malnutrition’ or ‘lean’ diabetes.
India has a high prevalence of diabetes, expected to
rise to 80 million by 2030. This includes many patients
with lean diabetes, with low body mass index (BMI) and
severe complications of diabetes. While rudimentary
tests have suggested defects in both insulin secretion
and action, no comprehensive metabolic studies have
been performed. It is therefore unclear as to how these
patients should be treated. Considering these patients
are frequently labeled as having type 1 diabetes mellitus,
insulin is the usual treatment. However, this is often
unaffordable and can cause fatal hypoglycemia among
poor patients with inconsistent food availability. |
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Interestingly,
various reports suggest that these patients are surprisingly
insulin resistant considering their lean body habitus.
Hepatic fat metabolism may be of considerable importance
in the regulation of glucose production in individuals
with lean diabetes and deficient fat stores in these
individuals may promote hepatic triglyceride storage,
leading to insulin resistance. |
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Therefore,
we are conducting comprehensive metabolic studies in
individuals with lean diabetes. Using BMI-matched non-diabetic
subjects and lean subjects with type 2 diabetes mellitus
as comparators, we are defining their body composition
and tissue triglyceride content, insulin secretion,
and hepatic and peripheral insulin sensitivity. Defining
the metabolic defects of lean diabetes should have tremendous
therapeutic benefit for millions of patients with this
elusive condition. The objectives of this research project
are the following: |
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a)
To characterize body composition and hepatic lipid deposition
in individuals with lean diabetes using DEXA scans and
MRI.
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b)
To characterize insulin’s ability to regulate glucose
fluxes and inhibit lipolysis in individuals with lean
diabetes using euglycemic-hyperinsulinemic pancreatic
clamp studies.
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c)
To assess the insulin secretory response to meal challenge
in individuals with lean diabetes using intravenous glucose
tolerance tests (IVGTT).
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d)
To characterize adipose tissue in individuals with lean
diabetes by analyzing subcutaneous abdominal adipose tissue
biopsies.
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he
collaboration between the Albert Einstein College of
Medicine and CMC-Vellore affords the opportunity of
studying this unique subject population with state-of-the-art
metabolic research techniques. |
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