Dr. Ashok Balasubramanyam is researching why some diabetics don’t necessarily fit the box of type 1 and type 2 and what he’s discovered is there’s probably a wide range.
“So at one end, you have very typical type 1. At the other end, you probably have something that’s very typical of type 2. But in between there’s a whole range of people who seem to have characteristics of both or who have something totally different in terms of the way they manifest,” Dr. Ashok Balasubramanyam, endocrinologist at Baylor St. Luke’s Medical Center, explained. “In other words, patients with type 1 diabetes are generally young and lean and don’t have any insulin in their bodies. But what if you’re not young and not lean and yet don’t have insulin in your body? What do you call that? So the same thing with people with type 2 diabetes. There are some patients who are very lean and yet they get a kind of type two diabetes. How do they fit?”
James Sweger from the Woodlands was 11 before he ever got a diagnosis of Type 1 diabetes. He struggled with health issues before he was hospitalized and finally diagnosed. While Sweger has not been determined to have atypical diabetes, stories like his are common for atypical patients, according to Dr. Balasubramanyam.
To potentially pave the way for better diagnosis and treatments, the National Institutes of Health (NIH) financed the Rare and atypical diabetes network (RADIANT), to investigate the causes of numerous unique kinds of diabetes.
“Amongst the many patients who have come through for RADIANT, there are quite a few who exactly fit that picture. They look like they have no insulin. They need insulin. They have all sorts of disturbing symptoms, but they don’t have those classic antibodies that people associate with autoimmune type 1 diabetes. So the question is, why did they get it?” Dr. Balasubramanyam wonders.
Dr. Balasubramanyam hypothesizes that our environment, genetics, even medical conditions (including PCOS and HIV) may lead to a type of diabetes that isn’t type 1 or type 2 and therefore may need better targeted treatment. He uses cancer as an example of how targeted treatments have helped save people’s lives and he believes diabetics are being ignored for more precise treatments, in part, because there’s a stigma the disease is brought on by unhealthy lifestyles.
“I think that’s particularly true amongst people who fall kind of in the overweight end of the spectrum because, you know, if the disease weren’t difficult enough to tackle, you now have the added burden of feeling that you did something to yourself ... one of the ways in which I think science really helps people and helps society is to be able to get down to the cause of something. When you find a cause, you’re so relieved that you don’t have the mystery surrounding it. You’re able to see whether future generations might or might not get it moving forward,” Dr. Balasubramanyam said.
More than 1,000 people with suspected atypical forms of diabetes have applied to participate in RADIANT. Active enrollment and investigations are ongoing.
Find out how you can apply if you suspect your diabetes isn’t typical at www.atypicaldiabetesnetwork.org.
Baylor College of Medicine and the University of Chicago are the lead centers of the program which includes a total of 15 clinical sites around the country.
