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Everything You Need to Know About Type 3 Diabetes

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06 October 2025

•

6 minute read

Everything you need to know about Type 3 Diabetes

By Dr. Radhamani A/p Rajakumar

This disease often hides in plain sight, and an endocrinologist shares why it’s time to talk about it

News has been circulating about a ‘new type of diabetes’, the Type 3 diabetes. Though is it really new?

Most of us grew up learning that there are only two types, so this definitely caught our attention. To clear things up, we spoke with Dr. Radhamani Rajakumar, Consultant Internal Medicine Physician & Endocrinologist at Columbia Asia Hospital Bukit Rimau, who helped us understand what this often-overlooked condition is really about.

What is Type 3c diabetes mellitus (T3cDM) in simple terms?

Type 3cDM is a secondary form of diabetes that develops when the pancreas is damaged, affecting its ability to produce insulin, which is essential for regulating blood sugar levels. It is also known as ‘pancreatogenic diabetes’.

A stethoscope and syringe on a diabetes file, highlighting diabetes diagnosis

How does it differ from the more familiar Type 1 and Type 2 diabetes?

Type 1 DM is an autoimmune disease that destroys insulin producing cells in the pancreas causing absolute insulin deficiency.

Meanwhile Type 2 DM occurs when the body resist the effects of insulin (insulin resistance) leading to elevated blood sugar levels.

Why is T3cDM so often misdiagnosed or overlooked, even among healthcare professionals?

T3cDM is difficult to diagnose, leading to underdiagnosis. It affects approximately 5% to 10% of people with diabetes but is often misclassified as type 1 or type 2 DM due to its overlapping clinical picture and under recognition of the contribution of pancreatic disease to the development of diabetes.

Doctor holding a pancreas model to explain pancreatic damage in Type 3c diabetes

From a clinical perspective, what are the key risk factors that might predispose someone to developing T3cDM? (eg. chronic pancreatitis, pancreatic cancer, or pancreatic surgery)

  1. Chronic pancreatitis (inflammation of the pancreas) mainly due to alcohol (80% of cases)
  2. Pancreatic cancer
  3. Following pancreatic surgery due to trauma
  4. Genetic disorders like cystic fibrosis (abnormal fluid secretion causing pancreas dysfunction) and haemochromatosis (excess iron deposition in the pancreas causing pancreatic failure)

Since there are no universally standardised diagnostic guidelines, how do doctors currently diagnose T3cDM in practice?

Detail clinical history, biochemical markers (testing for exocrine pancreatic insufficiency, absence of autoimmune markers for T1DM and assessment of B-cell function) together with advanced pancreatic imaging would help with the diagnosis of T3cDM

What are some of the challenges you face in distinguishing T3cDM from long-standing Type 2 diabetes in patients?

The pathogenesis of T3cDM is ultimately due to decreased insulin secretion and in long standing poorly controlled T2DM patient, persistent glucotoxicity state will lead to beta cell destruction causing impaired insulin secretion. And in the absence of pancreatic exocrine insufficiency such as malabsorption symptoms it will be difficult to distinguish between T3cDM and T2DM. They also share similar micro and macrovascular complications.

Person injecting insulin into the arm, showing insulin therapy for Type 3c diabetes

How is T3cDM usually managed, and how does this compare with treatment for Type 1 or Type 2 diabetes?

As for type 1 or type 2 DM, lifestyle modification mainly physical activity and dietary modification is also crucial in the management of T3cDM. Since the principal defect is insulin deficiency, insulin therapy is the preferred treatment for most patients with T3cDM. However, oral diabetic medication can be considered depending on degree of insulin deficiency.

Are there limitations to the medications or therapies we currently have for T3cDM patients? (eg. rely more heavily on insulin therapy)

Some of the oral medications may not be suitable depending on the pancreatic disease severity and duration. Apart from that, most of the oral diabetic medications requires functioning beta cells which is lacking in type 3cDM leading to insulin commencement even at the early stages.

Why is raising awareness of T3cDM important? (Not just among healthcare professionals, but also for the general public.)’

Since T3cDM is often misdiagnosed or underdiagnosed, raising awareness will help early detection or screening and timely treatment which could improve patient outcomes and quality of life.

Currently what are the statistics of T3cDM in Malaysia?

Unfortunately, there is no statistics of T3cDM in Malaysia. In Western populations, T3cDM is estimated to occur in 5%–10% of all diabetic patients, mostly due to chronic pancreatitis. However, true prevalence of T3cDM is unknown due to challenges with accurate diabetes classification in clinical practice

From your experience in Malaysia, do you think T3cDM is underdiagnosed here, and if so, why?

Yes, answer is similar to Q3

What would you like to see in terms of research, diagnostic tools, or guidelines to better support patients with T3cDM?

Given the atypical presentation, accurate diagnosis of T3cDM requires specific criteria to distinguish it from other forms of diabetes. There are some proposed diagnostic criteria however it’s not standardized. Hence, more targeted research and studies are essential to improve diagnosis, explore new treatments and uncover the root mechanisms behind Type 3c diabetes.

This article first appeared in 1Twenty80, 06 October 2025.

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06 October 2025

•

6 minute read

Everything you need to know about Type 3 Diabetes

By Dr. Radhamani A/p Rajakumar

Dr. Radhamani A/p Rajakumar

Internal Medicine And Endocrinology,internal Medicine

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