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0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ PI3K Inhibitor Library cost Peer-review started: September 4, 2014 First decision: November 14, 2014 Article in press: February 11, 2015 P- Reviewer: Magalhaes FO S- Editor: Ji FF L- Editor: A E- Editor: Wu HL""Core tip: Little is known about lean diabetes (patients with low-normal body mass index). Studies in developing countries have shown that these patients have history of childhood malnutrition, poor socioeconomic status and early age of onset with absence of ketosis. In the United States, recent studies showed that the lean, normal Fossariinae weight diabetes is not rare especially among minorities. These patients are mainly males and have higher prevalence of insulin use indicating rapid beta cell failure. They might have increased total, cardiovascular and non cardiovascular mortality when compared to obese diabetic patients. The potential causal mechanisms of this diabetes type may include genetic, acquired and behavioral factors. INTRODUCTION The prevalence of diabetes mellitus (DM) has increased exponentially over the past decade globally. In the United States, nearly 26 million adults have diabetes with over 9 million being prediabetic. The numbers are expected to double by 2050. Nearly 35% of American adults are obese putting them at an increased risk for the development of Diabetes. Healthy people 2020 initiative Sunitinib mouse has stressed the importance of reduction in obesity to lower the incidence of this morbid condition among the United States population[1]. Since early times obesity has been a well known risk factor for diabetes. However, beyond the classical obesity related type 2 diabetes and other well defined types of diabetes like type 1, Maturity onset Diabetes of the Young, Gestational diabetes, etc., there is a renewed interest in the underweight or normal weight lean diabetes that is emerging also in the developed countries like United States. This review will focus on the low-normal weight diabetes that is so far not well characterized and defined. More importantly, this review will highlight the differences in the clinical features of diabetes mellitus in normal body weight patients in the United States in comparison to the classical obese diabetes. The evidence related to the profile, peculiarities, morbidity, mortality and pathogenesis associated with lean type diabetes will be described. DIABETES IN LOW BODY WEIGHT GROUP (BODY MASS INDEX