Could People With a “New” Type of Diabetes Be Wrongly Diagnosed With Type 2?
According to researchers from the United Kingdom, people who have been diagnosed with a new type of diabetes — known as type 3c diabetes — are “frequently labeled” as having type 2. And the patients who are mistakenly being treated for type 2 have a “greater requirement for insulin.”
In a study published in the November 2017 issue of the journal Diabetes Care, which is published by the American Diabetes Association, investigators analyzed the medical records of more than 2.3 million people from England that were recorded between January 2005 and March 2016. After pinpointing those people — nearly 32,000 — who were diagnosed with adult-onset diabetes (which is commonly referred to as type 2), the authors concluded the following:
Diabetes following pancreatic disease — known as type 3c diabetes, which hinders the pancreas from producing digestive enzymes and insulin, as well as other hormones —was more common than type 1 diabetes.
The cases of diabetes following pancreatic disease (559) were mostly classified by clinicians as type 2 diabetes (87.8 percent) and uncommonly as diabetes of the exocrine pancreas (2.7 percent).
Diabetes following pancreatic disease was associated with poor glycemic control compared with type 2 diabetes.
As a result, patients with type 3c diabetes may not be receiving the most effective treatments. “Our findings highlight the urgent need for improved recognition and diagnosis of this surprisingly common type of diabetes,” stated Andrew McGovern, co-author of the study, in a follow-up article.
What Is Type 3c Diabetes? Breaking Down The Details
Let’s begin with the name. “Type 3c diabetes is more of a European term,” says Robert W. Lash, MD, the Endocrine Society’s incoming chief professional and clinical affairs officer. “The other term that is used by the American Diabetes Association and has been used in the past is pancreatogenic diabetes. But I think ‘diabetes of the exocrine pancreas’ is probably the better term, used because it explains what it is.”
Michael R. Rickels, MD, MS, an associate professor of medicine at the Hospital of the University of Pennsylvania who is also a member of the Endocrine Society, states that the type 3c category simply indicates a secondary cause of diabetes.
“So rather than considering the commonly understood mechanisms for the causes of type 1 [an autoimmune disease where the body destroys its ability to produce insulin in the pancreas] or type 2 [a chronic condition where the body is no longer able to produce enough insulin], individuals who develop type 3c have diabetes associated with a disorder of the exocrine pancreas,” states Dr. Rickels, who has conducted research on type 3c diabetes.
He further explains that patients with a history of acute, recurrent acute, or chronic pancreatitis, “where there is an inflammatory disorder of the pancreas, are those who are partially susceptible to developing diabetes associated with pancreatitis that would be considered type 3c diabetes.”
Dr. Lash adds that individuals who have experienced severe damage to the pancreas due to other medical or surgical reasons, such as cystic fibrosis or an automobile accident, would also be at risk. “Our general rule of thumb is you have to lose the vast majority of your pancreatic function before you get diabetes.”
While he feels this study is “interesting” because it not only brings awareness to this type of diabetes, along with the fact that — generally speaking — people with type 3c tend to need more insulin, he understands the reason for the “misdiagnosed” cases.
“One of the points the paper is making is that if you do get diabetes of the exocrine pancreatic origin, it’s often labeled as type 2,” says Lash. “So when a patient leaves the hospital, they may hear they have type 2, but what the patient may have is diabetes of the exocrine pancreas. And the question becomes, how important is this? At the end of the day, patients with diabetes in this category go on insulin if they need to — and they don’t go on insulin if they don’t. And what you call it is much less important than following your patient’s glucoses and giving them the appropriate medicine.”
Type 3c Diabetes: The Bottom Line
Rickels concludes by saying a patient who has been diagnosed with either type 1 or type 2 diabetes and has no history of pancreatitis or other disease of the pancreas, and has not had pancreatic surgery, has most likely been diagnosed correctly.
“So if you have type 2 diabetes, you should not be walking around worried that you’ve damaged your exocrine pancreas,” says Lash.
It’s also interesting to note that this type of diabetes isn’t necessarily breaking news to those in the medical world. “It’s been around forever,” says Lash.
This story was written by Amy Capetta, who has been writing for women’s lifestyle publications for nearly two decades. Over the years, her work has appeared in Family Circle, Weight Watchers, and Prevention, as well as on AOL Health, TODAY.com, Yahoo, WomansDay.com, SELF.com, and Dr. Oz The Good Life.com. In her spare time, she is most likely power walking, on the yoga mat, reading cookbooks, or catching up on Days of our Lives.
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