Even as India is sitting on a ticking time bomb of type-2 diabetes, a new category of the disease has begun to spread menacingly, necessitating redirection of treatment and management modalities.
Called Type-1.5 (one and a half) or latent autoimmune disease in adults (LADA), the condition is being increasingly detected in patients perceived to be suffering from type-2 diabetes. More than 30 per cent of clinically diagnosed type-2 diabetes patients are actually type 1.5, which like type-1 diabetes is absolutely insulin dependent, a hospital-based study by the Kanungo Institute of Diabetes Specialities (KIDS) has revealed.
Type 1.5 is type-1 diabetes that develops slowly in adults. Type-1 diabetes, caused by autoimmune destruction of insulin producing betacells in the pancreas, is completely insulin dependent. It though manifests at very early age even in infants. On the other hand, in case of type-2 present among adults, insulin action is compromised but is not completely obliterated. With residual amount of betacells remaining in the pancreas, the patients are mostly not insulin-dependent. They can be managed by oral medications combined with lifestyle modifications.
However, an increasing number of type-2 patients is being found to stop responding to oral medications after sometime and requiring insulin treatment. About 1,200 type-2 diabetes patients were subjected to genetic studies for autoimmune diabetes in adults. Of them, 30-35 per cent were found to be actually type-1.5 or slow onset of type-1 diabetes manifesting in adulthood, chairman and chief consultant diabetologist, KIDS, Dr Alok Kanungo said. “The results are astounding. With such a high proportion of patients being type-1.5, new diagnosis and treatment modalities should be adopted. Patients not responding to oral medications should be examined for antibody markers as GAD-2 and IA-2 and treatment regimen should be redirected. Early insulin therapy will protect their betacells from getting further damaged,” he said.
Dr Kanungo presented a paper on these findings at the National Diabetes Conference of the Research Society for the Study of Diabetes in India (RSSDI) in New Delhi recently.
Type-2 diabetes has turned an epidemic in India and the State with more than 63 million and four million patients respectively. Its incidence is estimated to be over nine per cent while type-1 or juvenile diabetes is as low as 0.5 per cent of the population.
While type-1.5 may have emerged a new worry, it has also good news as vaccines are being developed for it. The vaccine Diamyd, which intends to intervene in the autoimmune process at an early stage, and thus prevent the disease from developing, is in advanced trial stages and likely to be introduced soon.