P-237: Malnutrition-related diabetes mellitus (type 5) in Nigerian siblings: a case series highlighting clinical presentation and treatment outcomes
L Nwokeji-Onwe, N Omeje, J Eze, T Nnaji, F AttahAbstract
Introduction
Type 5 diabetes mellitus, or malnutrition-related diabetes mellitus (MRDM), is a rare form affecting malnourished populations. It is characterized by insulin deficiency without autoimmune markers, severe nutritional deficits, and pancreatic abnormalities. Early diagnosis is vital to reduce morbidity and mortality; however, data from Nigeria are limited.
Objectives
To describe the clinical presentation, biochemical features, and management outcomes of two siblings diagnosed with Type 5 diabetes in Abakaliki, Nigeria.
Methods
We retrospectively reviewed two siblings, aged 16 and 18 years, from a low socioeconomic background presenting with severe malnutrition and hyperglycemia suggestive of MRDM. Clinical data and laboratory investigations—including HbA1c, C-peptide, liver function tests, urinalysis, and abdominal ultrasound—were analyzed. Both were managed with insulin therapy and nutritional rehabilitation. Clinical course and outcomes were documented.
Results
The male sibling had a 7-month history of recurrent fever, bilateral leg swelling, weight loss, and classic diabetes symptoms; BMI was 11.96 kg/m2. The female sibling presented with abdominal pain, weight loss, bilateral leg edema, and diabetic symptoms; BMI was 11.59 kg/m2. Both had HbA1c >14%, low but detectable C-peptide, anemia (PCV 24% and 29.9%), and deranged liver enzymes. Ultrasound showed shrunken, calcified pancreas in both. Treatment with low-dose insulin and nutritional support resolved edema, improved anemia, cleared infections, and normalized blood glucose. The female transitioned to insulin combined with oral hypoglycemics.
Conclusions
These cases illustrate the complex presentation of Type 5 diabetes in malnourished siblings. Early recognition and integrated metabolic and nutritional management are essential to improve outcomes in resource-limited settings.