Case Report Series: Malnutrition Related Diabetes Mellitus (MRDM)
DOI:
https://doi.org/10.14738/bjhr.1204.19201Keywords:
Malnutrition Related Diabetes Mellitus, Protein Deficiency, Cassava, Infections, Indigenous Spirits, Pancreatic CalcificationAbstract
This case report series describes three patients with malnutrition related diabetes mellitus (MRDM) managed by the author as a senior resident doctor at the University College Hospital, Ibadan, Nigeria, between 1987 and 1990. The article outlines how the World Health Organization classified MRDM as a distinct entity in 1985, removed it in 1999, and in 2019 placed it among diseases of the exocrine pancreas as fibrocalculous pancreatopathy. The patients were a 24-year-old woman and a 24-year-old man with abdominal pain, low body mass index, marked hyperglycaemia and pancreatic calcification, the second developing a hyperglycaemic pre-coma state in hospital, and a 50-year-old man with known diabetes, pancreatic calcification and recurrent pulmonary tuberculosis. Blood sugar was controlled with Lente insulin in two patients and with glibenclamide in one, and all improved on follow-up. The discussion reviews the history of the condition and its suggested causes, including cassava consumption with inadequate dietary protein, through the toxic effect of hydrocyanic acid on islet cells, as well as hereditary factors, infections, indigenous spirits and herbal medicines. The author notes that MRDM, common at that time, has become very rare in the past three decades, probably because of better cassava preparation, better diets, knowledge and lifestyles, and urges physicians to report cases given the risk of resurgence.
Abstract prepared by the editorial office from the full text of the article; the authors did not supply one.
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