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lean diabetes is rare, affecting about two per cent of people with type 2 diabetes

when someone lean is diagnosed with type 2 diabetes, they may be at an increased risk for vision and nerve damage, poor blood circulation, kidney and heart disease.

by maja begovic
published nov 09, 2022
read time 6 minute read
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read time 6 minute read
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out-of-pocket expenses are just one challenge facing diabetes patients
apart from genetics, there is also evidence that suggests that an abnormal cholesterol profile may also put someone at an increased risk for lean diabetes. getty
for years, sasha begovic, a senior engineer in the automotive industry, kept a gruelling schedule. he would usually head off to work after four hours of sleep and work well into the evening, including on weekends. when he wasn’t at the auto plant, he’d travel for business either to the u.s. or japan, but even those long flights and shifting time zones didn’t seem to slow him down. he didn’t have time to exercise, and his diet wasn’t the best — he would sometimes skip meals and grab the first thing that was available, which a lot of the time, wasn’t the healthiest option. still, the busy schedule and a few hours of sleep a night didn’t appear to impact his immune system — or his weight. he would barely catch a cold every few years, and at six feet tall, he was always lean. six years ago, while traveling for work, he felt an overwhelming craving for sugar. assuming that it had something to do with lack of sleep, he gave in to the cravings, but soon after he returned to toronto, he felt sick and developed a fever. within a few hours, he was in the er where blood work results showed he had elevated blood sugar levels. when he followed up with his family physician, he was told that he had prediabetes, a condition that puts him at risk for type 2 diabetes, but that with lifestyle modifications, he could successfully return his blood sugar level to the normal range. for the first few months, sasha was disciplined and while he did make lifestyle changes, it didn’t take long for him to return to his previous schedule and habits. a year later, he was formally diagnosed with type 2 diabetes and put on daily medication to help control the disease.

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“i didn’t feel great about the diagnosis,” he says. “obviously, i worried about how it would impact my health, my work, my daily activities and whether or not it would shorten my life.”
for sasha begovic, living with diabetes has forced him to adjust his work schedule, prioritize sleep and commit to daily physical activity. supplied
for sasha begovic, living with diabetes has forced him to adjust his work schedule, prioritize sleep and commit to daily physical activity. supplied
dr. caroline kramer, endocrinologist and clinician scientist at the leadership sinai centre for diabetes at mount sinai hospital in toronto, says that while type 2 diabetes is a condition that is most often associated with elevated weight or obesity, when it occurs in individuals with normal body mass index (bmi), it is referred to as lean diabetes. in scientific literature, lean diabetes is explained by the thin-fat phenotype or high body fat percentage or metabolic obesity in individuals with normal body weight. kramer suggests that lean diabetes is extremely rare, affecting one to two per cent of those with type 2 diabetes, and symptoms can include increased thirst, weight loss, frequent urination and fungal infections. the risk for it increases after age 45.
when someone lean is diagnosed with type 2 diabetes, they may be at an increased risk for vision and nerve damage, poor blood circulation, kidney and heart disease. more severe complications, such as foot ulcers that may require amputation, are also possible, in addition to the disease progressing to the point where it may require insulin treatment.

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“patients can develop diabetes even when they are lean,” says kramer. “we don’t really know why that happens, but some individuals have a genetic background for it and there are some studies that suggest that lean people with type 2 diabetes can experience worse prognosis as this condition is usually associated with more severe degree of pancreatic dysfunction.”
one study published in the journal of the american medical association suggests that lean patients with type 2 diabetes appear to not only be metabolically similar to those who were obese, they were also twice as likely to die at any point than those who had excess weight. the study followed 2,625 people who were diagnosed with diabetes from 1990 to 2011, 12 per cent of whom had normal weight. the authors suggest that more research is needed to determine why this happens, but their findings suggest that “genetic predisposition to improper insulin production” may be a part of the problem. researchers are urging physicians to be vigilant for early signs of diabetes in their lean and normal weight patients.

what does poverty and stress have to do with diabetes?

apart from genetics, there is also evidence that suggests that an abnormal cholesterol profile may also put someone at an increased risk for lean diabetes, but perhaps the biggest culprits of type 2 diabetes according to some experts — regardless of whether it stems from classic or metabolic obesity — may be linked to social, economic and environmental factors. poverty, stress, sedentary lifestyle that may stem from a work-life imbalance or living in a city that is unwalkable, as well as inequitable access to healthy foods and timely health care, enable the disease to spread like wildfire, they suggest.
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“our entire society is perfectly designed to create type 2 diabetes,” dr. dean schillinger, a professor of medicine at the university of california, san francisco told the new york times. “we have to disrupt that.”
according to diabetes canada, 11.7 million people are living with diabetes and prediabetes in this country alone, but globally, it appears to run equally rampant. the world health organization estimates that the number of people affected rose from 108 million people in 1980 to 422 million in 2014.

one person is diagnosed with diabetes every three minutes

laura syron, president & ceo of diabetes canada who also lives with type 2 diabetes, says that in the next decade, the number of people living with diabetes and prediabetes in canada is expected to increase by 19 per cent. currently, there are 640 new cases daily, 26 cases hourly or one every three minutes, and the annual cost of diabetes to the healthcare system is estimated to be $30 billion.
“people living with, or affected by, diabetes may experience many burdens, both those that are painfully obvious as well those that are insidious, yet equally devastating,” says syron. “all too often, it can affect both people’s emotional and financial well-being.”
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the biggest issues people with diabetes face, according to syron, are the out-of-pocket expenses and a patchwork system of different standards of care and access to supports that exist across the country.
last month, to help make things right for people affected by diabetes, health minister jean-yves duclos tabled the framework for diabetes in canada — a national policy that aims to improve access to disease prevention and treatment. but while syron agrees that this is a significant step, she suggests that to fully benefit the people it was designed to support, the framework “must be funded and implemented in the 2023 budget cycle federally, and in the provinces and territories.”
diabetes canada has developed a five-point plan to fund the framework, and the proposal is calling on the federal, provincial and territorial governments to invest in innovative diabetes research, equitable access to critical resources and tools, more public education and disease awareness, and a commitment to measurable progress and accountability, comprehensive data sharing and reporting.
“if implemented and invested in, [the plan] would have an immediate and tangible impact on the millions of canadians who live with diabetes and those that care for them,” says syron.
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type 2 diabetes is a lifelong condition and while it isn’t reversible, it can be successfully managed. according to kramer, some of the most powerful tools include a healthy lifestyle, physical activity — even if a person is lean — and a balanced diet that’s rich in low glycemic foods and fruits as well as vegetables and grains while avoiding processed foods or those with high-sugar content.
for sasha, living with diabetes has forced him to adjust his work schedule, prioritize sleep and commit to daily physical activity. walking, resistance training and biking 40 kilometres on weekends have helped him to fully appreciate the positive impact consistent daily actions have on his health.
“the numbers don’t lie,” says sasha. “it’s not enough to just rely just on daily medication to manage diabetes — you have to put in the effort too.”
 
 maja begovic is a toronto-based writer, and the partner of sasha begovic.  
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