DIABETES: SO WHAT IS YOUR TYPE?
Increasingly, Patients Are Wrongly Diagnosed For Type And Put On Insulin When They Need Just Sugar-Controlling Pill
TIMES NEWS NETWORK
Chennai: Two weeks ago, when 21-year-old Satish, a software engineer, drew out an insulin pen and injected himself with the drug while travelling, he was telling his fellow passenger in the train how his life had changed ever since doctors had diagnosed him as a diabetic a week ago. He was advised to inject the drug at least twice a day, before a meal.
Fortunately for Satish, his travelling companion was a well-known diabetologist, and the latter wasn’t quite convinced that Satish required insulin. Two days later in his clinic, Dr V Mohan, chairman, Dr Mohan’s Diabetes Centre, found that his gut feeling was indeed right. Tests showed that Satish was wrongly diagnosed with Type 1, insulin-dependent diabetes. His elevated sugar level was a result of his lifestyle. “He was clearly a Type 2 diabetic and all he required was some tablets to keep his blood sugar under control,” Dr Mohan pointed out.
With an increasing number of youngsters getting affected by Type 2 (non-insulin-dependent diabetes), diabetologists such as Dr Mohan are concerned that increasingly, wrong diagnosis leading to unnecessary injections of insulin. Until a few decades ago, more than 80% of diabetes cases under the age of 25 were termed ‘juvenile diabetes’, which required insulin. Today, the Indian Council of Medical Research (ICMR) diabetes registry, which includes data collected from a few diabetologists in Chennai, has 2,384 diabetes patients younger than 25 years of age. Of that number, 1,088 have Type 1 diabetes, and 1,091 have Type 2.
“Type 2 diabetes is fast catching up. We have several children who are obese and at risk for lifestyle-related diseases,” said Dr Vijay Vishwanath, MV Hospital for Diabetes. “Lack of exercise and junk food are certainly to be blamed. While wrong diagnosis is bad, what makes things worse is that many of them are still waiting to be diagnosed,” he added.
Unfortunately, lack of diabetologists and adequate facilities are resulting in the disorder being wrongly treated. A five-year ongoing study on diabetes involving 1,755 Indian participants, conducted by Dr A Ramachandran, chairman, Dr A Ramachandran’s Diabetes Hospitals, revealed that diabetes was poorly controlled in India. “The onset of diabetes in our country is significantly early, compared to the west. Most Indians do not achieve the treatment goals based on international guidelines,” he said.
Senior diabetologists recommend that the treatment and management of the disease should be included in undergraduate medical programmes and that awareness about the disease should be a part of school curriculum.
SOME FROM YOUR STYLE, SOME FROM YOUR GENES
What is diabetes?
It’s a condition in which the body either does not produce enough or does not properly respond to insulin — a hormone produced in the pancreas. This causes glucose to accumulate in the blood. Insulin enables cells to absorb glucose
Common types of diabetes
Type 1: Results from the body's failure to produce insulin. Almost all persons with type 1 diabetes must take insulin injections.
Type 2: Results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with relative insulin deficiency OTHER FORMS OF DIABETES
Fibrocalculous pancreatic diabetes: It is a unique form of diabetes — secondary to chronic pancreatitis seen in developing countries of the world —associated with either overt protein-calorie malnutrition or, more likely, with deficiency of certain micronutrients
MODY (Maturity-onset of diabetes in youth) It refers to any of several hereditary forms of diabetes caused by mutations in an autosomal dominant gene (sex independent, i.e. inherited from any of the parents) disrupting insulin production
Gestational diabetes Pregnant women, who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. It may precede development of type 2 (or rarely type 1) A new standard for diagnosis?
Chennai: Should the haemoglobin A1c assay, commonly referred to as the HbA1C test, be the new standard test for diabetes? Does it provide better diagnosis than current tests such as fasting sugar and post prandial (taken two hours after meal) tests?
Diabetologists in the city have been debating on this, after the American Diabetology Association suggested that it be made the gold standard for diabetes. The committee appointed by the association had recommended that patients with an HbA1c of 6.5% or higher should be declared diabetic.
The HbA1C reference is a blood test that provides the average sugar level for three months. The test, though three times more expensive when compared to the fasting blood sugar test or home glucose test that costs Rs 50, measures average blood glucose over the preceding two to three months.
The HbA1C test has some major advantages, says diabetologist Dr A Ramachandran. “Its values vary less than fasting plasma glucose values. Also, testing for diabetes using this method is easier for patients, who will no longer be required to fast and follow it up with another test two hours after a meal,” he said. But interim results of a multi-centric study shows that a substantial number of diabetics have not done the test even once. “It should be used at least in combination with fasting blood glucose test if not as a first-line tool,” he said. The senior diabetologist recommend HbA1c screening at least twice a year. But how many physicians would want this as a first-line tool? “It is a fantastic measuring tool. But one has to be extremely careful as it can show up some false negatives. We might miss out early diagnosis as it may not pick up people in the pre-diabetic stage,” says Dr Mohan. “It works best in combination. If a doctor has doubts that the results from HbAiC could be wrong, a fasting test should be conducted,” he said.
Mutation identified after 2-yr-long research
Chennai: Doctors identified the the typical Indian forms of mutations of the gene involved in controlling insulin production after a two-year study.
It began with short interviews of 16-year-old Haritha’s parents, Savitha and Balamurugan, before doctors invited the family for a screening. After finding that eight members on Savitha’s side and two from Balamuragan’s family were diabetic, doctors put them all through a genetic test. “As expected all the eight diabetics in Savitha’s family had the same gene mutation. It was absent in Balamurugan and other non-diabetic members,” said Dr Mohan.
Initially, the family was in denial mode. “I was too scared for my daughters. Now that we know it is genetic, who will marry them?” asked Savitha.
But the research showed that it wasn’t just their family. Of the 96 clinically diagnosed cases of MODY, nearly 10% had MODY 3 and 5% percent had MODY 1. “We will have to screen people for other types. But what is stunning is that we are seeing mutations in the gene that we have not seen anywhere else. These are typically Indian forms of mutations,” said Mohan.
(All names changed on request)
