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However, elevated cortisol levels of 15.2 mcg/L (afternoon (PM) range: 4-9.9 mcg/L) and decreased total testosterone levels, from 832 ng/dL in 2011 to 405 ng/dL (193-950 ng/dL) in June 2015, were observed

It is believed that protein and micronutrient deficiencies in early childhood impair pancreatic development and -cell function, ultimately reducing insulin secretion through pathways involving oxidative stress-induced -cell apoptosis and epigenetic alterations in key transcriptional regulators of insulin gene expression, such as PDX1 and MafA [144,145,146] The recognition of Type 5 diabetes highlights undernutrition as an independent mechanistic driver of metabolic disease and reinforcing the need for nutritional and context-specific therapeutic strategies in affected populations