The hidden danger

> The third and least known form of diabetes, Type-3c, is quite common, but most doctors end up overlooking it

MOST people are familiar with Type-1 and Type-2 diabetes. Recently, however, a new type of diabetes has been identified: Type-3c diabetes. Type-1 diabetes is where the body’s immune system destroys the insulinproducing cells of the pancreas. It usually starts in childhood or early adulthood and almost always needs insulin treatment.

Type-2 diabetes occurs when the pancreas can’t keep up with the insulin demand of the body. It is often associated with being overweight or obese and usually starts in middle or old age, although the age of onset is decreasing.

On the other hand, Type-3c diabetes is caused by damage to the pancreas from inflammation of the pancreas (pancreatitis), tumours of the pancreas, or pancreatic surgery.

This type of damage to the pancreas not only impairs the organ’s ability to produce insulin, but also to produce the proteins needed to digest food (digestive enzymes) and other hormones.

However, a new British study has revealed that most cases of Type-3c diabetes are being wrongly diagnosed as Type2 diabetes.

Only 3% of the people in a sample of more than two million were correctly identified as havingType-3c diabetes.

Small studies in specialist centres have found that most people with Type-3c diabetes need insulin and, unlike those with other diabetes types, can also benefit from taking digestive enzymes with food. These are taken as a tablet with meals and snacks.

Researchers and specialist doctors have recently become concerned that Type-3c diabetes might be much more common than previously thought, and that many cases are not being correctly identified.

Researchers looked for cases of diabetes occurring after conditions which had caused damage to the pancreas, including pancreatitis, pancreatic cancer and tumours, and pancreatic surgery. These cases of diabetes were found to be most likely Type-3c diabetes. The proportion of people with diseases of the pancreas who go on to develop diabetes is not clear, but it does not happen in all cases, and there may be a long delay before the onset of diabetes. Researchers also found that in adults, Type-3c diabetes was more common than Type-1 diabetes, concluding that 1% of new cases of diabetes were Type-1, compared with 1.6% for Type-3c. People with Type-3c diabetes were twice as likely to have poor blood sugar control than those with Type-2 diabetes. They were also five to 10 times more likely to need insulin, depending on their type of pancreas disease.

Researchers also found that the onset of Type-3c diabetes could occur long after the onset of pancreas injury – in many cases, more than a decade later.

This long lag may be one of the reasons the two events are not often thought of as being linked, and the diagnosis of Type-3c diabetes is being overlooked.

Correctly identifying the type of diabetes is important as it helps the selection of the correct treatment. Several drugs used for Type-2 diabetes, such as gliclazide, may not be as effective in Type3c diabetes.

Misdiagnosis, therefore, can waste time and money attempting ineffective treatments while exposing the patient to high blood sugar levels.

These findings highlight the urgent need for improved recognition and diagnosis of this surprisingly common type of diabetes. – The Independent