Most people are aware of type 1 and type 2 diabetes, but did you know there is a type 3 diabetes as well! It is a more obscure term. Although it is not an accepted medical diagnosis, type 3 diabetes has been discussed in the literature as a possible relationship between insulin resistance in the brain and Alzheimer's disease. This link has been described to help explain how metabolic disorders impact brain health, causing cognitive decline and dementia.

What is Type 3 Diabetes?

Type 3 diabetes is more of a misnomer because it should not be confused with type 3c diabetes, which relates to pancreatic dysfunction. The term "type 3 diabetes," on the other hand, has been loosely used by some scientists to analogously propose that Alzheimer's disease is strongly implicated with insulin resistance in the brain.

This concept was conceptualized by Dr. Suzanne de la Monte and Dr. Jack Wands of Brown University in the year 2008. This hypothesis postulated that Alzheimer's disease may be called type 3 diabetes for it bears many similarities with glucose metabolism disorder type 2 diabetes. Their concept arises from the basic principle that insulin is fundamental to blood sugar regulation, but it is also the case with the brain. When brain cells become insulin-resistant, they lose access to glucose, impairing their function.

Research published in the Journal of Diabetes Science and Technology supports this hypothesis by indicating that insulin resistance can be a significant contributor to the occurrence of dementia, also referred to as Alzheimer's. The symptoms of memory loss and diminished reasoning are associated with impaired glucose metabolism in the body, especially in the cerebral tissue.

Symptoms of Type 3 Diabetes

Although type 3 diabetes is not a "medical term," its symptoms correlate well with Alzheimer's diseases that are known to reduce the ability to think in an efficient manner and bring down brain health. These signs are:

- Loss of memory, especially short-term.

- Poor judgment and judgment ability

- Failure in recognizing people or places familiar once.

- Failure in the process of reading, writing or processing numbers

- Anxiety, agitation, or mood changes.

- Disorganized thoughts or confusion

- Lack of impulse control

As the disease advances, patients may be afflicted with severe complications including an inability to swallow or control their bodily functions. In the final stages, most patients die from fatal complications such as aspiration pneumonia.

Causes of Type 3 Diabetes

This may not be well understood with regards to type 3 diabetes, or the exact link between insulin resistance and Alzheimer's disease. Some identified contributing factors include the following:

1. Insulin Resistance

Insulin acts as an important regulatory mechanism of brain functions such as memory and cognition. The reduction in insulin signaling may impair metabolism of brain cells, thus bringing about neurodegeneration.

2. Type 2 Diabetes

These diseases show a strong relationship and those individuals diagnosed with type 2 diabetes have double chances of getting Alzheimer's. In the two, the main causes can be chronic inflammation, oxidative stress, and a defect in glucose metabolism.

3. Environmental and Lifestyle Factors

Insulin resistance associated with obesity, stress, and an unhealthy diet is considered a cause that may increase the chances of Alzheimer's disease.

Researches in Frontiers in Neuroscience and The Lancet Neurology have also highlighted that drugs used for antidiabetic medication may be crucial for the prevention or at least slowing down the course of Alzheimer's.

Treatments for Type 3 Diabetes

In 2022, in a study in Pharmaceuticals, researchers studied biomarker uptake in brain regions implicated in the faulty uptake and metabolism of blood sugar in Alzheimer’s patients.

Emerging Therapies

Research into such treatments as intranasal insulin has also been promising. Intranasal delivery of insulin directly to the brain has been reported to enhance glucose uptake by brain cells, improve memory, and boost cognitive performance. While such clinical trials have been shown to be successful, additional research is needed for safety and efficacy.

Medications

For patients being aggressive or agitated, antipsychotic drugs may be prescribed; however, therapies such as cognitive rehabilitation as well as cognitive stimulation therapy serve to preserve memory and executive function.

Lifestyle Interventions

Diet, exercise, and stress management are critical in preventing and managing insulin resistance. A review in the Journal of Alzheimer's Disease also highlighted the benefits of Kirtan Kriya meditation, which can regulate genes involved in insulin and glucose metabolism, improve sleep, and reduce inflammation.

Can Type 3 Diabetes Be Prevented?

Although type 3 diabetes is not officially recognized, its connection to Alzheimer’s disease underscores the importance of proactive measures for brain health. Some prevention strategies include:

1. Healthy Diet

Consuming a balanced diet rich in antioxidants, whole grains, and healthy fats may support brain health.

2. Regular Exercise

Physical activity improves insulin sensitivity, reduces inflammation, and enhances overall metabolic health.

3. Stress Reduction

Mindfulness practices, including meditation, have been shown to lower stress levels, which can reduce the risk of cognitive decline.

The term type 3 diabetes brings out the complex relationship between metabolic disorders and brain health. Even though it is not a recognized medical condition, the concept emphasizes the crucial role of insulin in brain function and its possible contribution to Alzheimer's disease. Continued research will hopefully provide hope for therapies such as intranasal insulin and lifestyle modifications.

For decades, thalassemia has been synonymous with lifelong blood transfusions, frequent hospital visits, and the persistent risk of iron overload. For patients and families, it has largely meant managing a chronic condition rather than truly treating it. That narrative, however, is beginning to change.

The recent approval of oral drugs for thalassemia by the US Food and Drug Administration marks a historic milestone. These oral, disease-modifying pyruvate kinase activators improve anemia in adults with non-transfusion-dependent (NTDT) and transfusion-dependent (TDT) \(\alpha\)- or \(\beta\)-thalassemia. For now, they are approved in the US and Saudi Arabia for adults with thalassemia, with European review ongoing.

It is offering a fundamentally different approach, one that targets the disease at its biological core rather than simply managing its complications. Yet, as this new era unfolds, a critical question remains: are patients being diagnosed early enough to benefit from it?

A shift from supportive care to targeted therapy:

Until recently, thalassemia management has depended heavily on blood transfusions and iron chelation therapy. While these interventions are life-saving, they do not correct the underlying defect in red blood cell production. Over time, repeated transfusions can lead to complications affecting vital organs such as the heart, liver, and endocrine system.

Oral drugs, however, work by activating pyruvate kinase in red blood cells, improving energy (ATP) production, and enhancing red cell survival. In simple terms, it helps the body produce more functional and longer-lasting red blood cells, leading to an increase in hemoglobin levels, reduced transfusion requirements, and improved quality of life, particularly with respect to fatigue, one of the most debilitating symptoms of the disease. Oral therapy working across a broader disease spectrum marks a significant advance.

India’s Hidden Burden

India bears one of the highest burdens of thalassemia globally, with an estimated 10,000–15,000 affected children born each year and a carrier frequency of approximately 3–4% in the general population. Despite this, a large number of cases remain undiagnosed or are diagnosed late, particularly in individuals with milder forms who may live for years with unexplained anemia.

Delayed diagnosis has far-reaching consequences. Patients may develop preventable complications, families miss opportunities for genetic counseling, and access to emerging therapies is delayed or entirely missed. In the era of precision medicine, such delays are no longer acceptable.

The Problem Of Misdiagnosis

A major challenge in India is the frequent misdiagnosis of thalassemia as iron deficiency anemia, especially in primary care settings. Many patients receive repeated courses of iron supplementation without clinical improvement, while the underlying genetic disorder remains unrecognized.

Certain clinical clues should prompt further evaluation: persistent microcytic anemia unresponsive to iron therapy, a family history of anemia or transfusion dependence, and a disproportionately high red blood cell count relative to hemoglobin levels. Diagnostic confirmation is straightforward with hemoglobin analysis using HPLC or electrophoresis; however, these tests are not always utilized at the appropriate time.

Diagnosis And Screening

The approval of oral drugs underscores a fundamental shift, from managing symptoms to modifying disease biology. However, these benefits are maximized when therapy is initiated early, before irreversible organ damage occurs, for which timely diagnosis is pivotal.

Thalassemia diagnosis begins with a complete blood count demonstrating microcytic anemia with low mean corpuscular volume and a relatively high red cell count. Peripheral smear findings include target cells and anisopoikilocytosis. Confirmation is achieved through hemoglobin analysis using HPLC or electrophoresis, which typically shows elevated HbA₂ in β-thalassemia trait. Molecular testing further identifies specific gene mutations, enabling definitive diagnosis and prenatal counseling.

Screening programs play a pivotal role. Carrier detection through HbA₂ estimation, premarital and antenatal screening, and cascade testing within families are essential strategies, particularly in high-prevalence populations like India.

The mutation spectrum in India is well characterized. The most common β-thalassemia mutation is IVS-I-5 (G→C), accounting for nearly half of cases, followed by IVS-I-1 (G→T), codon 41/42 deletion, codon 8/9 insertion, and the 619 bp deletion. In α-thalassemia, the –α³․⁷ deletion predominates. This knowledge allows for cost-effective targeted molecular screening.

For years, the central question in thalassemia was: how do we manage this disease?

Today, it is shifting to: how early can we treat it effectively? Oral drugs represent a major therapeutic advance; however, cost considerations, accessibility, and long-term real-world outcomes will influence their widespread adoption. Nevertheless, the direction is clear: thalassemia care is entering a transformative era. In modern medicine, early diagnosis is no longer just beneficial; it is truly transformative.

While the confirmation of the Andes strain of hantavirus behind the outbreak aboard the cruise ship MV Hondius in the South Atlantic has raised significant concerns of human-to-human transmission, experts from the International Hantavirus Society, as well as the World Health Organization (WHO), stated that the situation does not raise the risk of a pandemic.

So far, eight cases have been reported, including three deaths. The WHO has also confirmed that six cases have tested positive for the Andes virus, which can spread from person to person, through PCR testing.

The International Hantavirus Society, in a statement, warned that the virus differs significantly from most other hantaviruses because it can spread between people.

Founded in 2001, the Hantavirus Society is a global organization of scientists, clinicians, and researchers focused on studying hantaviruses, including their ecology, pathogenesis, and prevention.

“The virus on board the MV Hondius is the Andes strain of hantavirus. It is serious,” said the WHO chief Tedros Adhanom Ghebreyesus, in an open statement on the social media platform X.

However, the WHO and the members of the Hantavirus Society maintained that the current outbreak is not another COVID-19 outbreak.

So, first, let us understand all about the Andes Virus.

What Is Andes Virus

The Andes virus is a rare but highly dangerous pathogen of hantavirus, found primarily in Argentina and Chile. It is the only type of hantavirus known to man to spread among humans.

Unlike many hantaviruses seen in Europe, Asia, and North America, which are typically transmitted from infected rodents to humans, the Andes virus has repeatedly shown evidence of person-to-person spread.

As per experts, transmission usually occurs in situations involving prolonged or close contact. But how close is a question that has been recurring. The Hantavirus Society answers this.

“Over the past decades, multiple outbreak investigations, household clusters, nosocomial events, and genomic analyses have provided convincing evidence that ANDV can be transmitted between individuals under specific close-contact conditions. These may include household exposure, intimate contact, caregiving without suitable personal protective equipment, and prolonged exposure in poorly ventilated or crowded settings,” it said.

Pointing out decades of outbreak investigations, hospital clusters, and genetic studies, experts emphasized: “Human-to-human transmission of Andes virus should no longer be considered hypothetical”.

The scientists stressed that current evidence does not suggest the virus spreads easily through casual community interaction in the way diseases like measles, influenza, or COVID-19 do.

Also Read: Hantavirus Outbreak: How MV Hondius Passengers Will Be Screened And Evacuated

Andes Virus: High Fatality Rate A Concern

But the Andes virus is associated with hantavirus pulmonary syndrome (HPS) — a severe respiratory illness that can rapidly become fatal. Reported fatality rates range from 20% to 40%, depending on the outbreak setting, quality of medical care, and surveillance capacity.

Recent surveillance data highlight the seriousness of the disease:

• Argentina reported 86 confirmed hantavirus cases in 2025, including 28 deaths.
• Chile reported 35 confirmed cases, including 7 deaths.

Why Continuous Monitoring Is Important?

The first major indication of person-to-person transmission emerged during the 1996 El Bolsón/Esquel outbreak. More recently, the 2018–2019 Epuyén outbreak infected 34 people after a single index case attended crowded social gatherings while symptomatic.

Strict public health interventions — including isolation, quarantine, and active contact tracing — reduced transmission.

Read More: Hantavirus: Israel Confirms 1st Case as UK, Spain Probe Suspected Infections; Should You Be Worried?

The Hantavirus Society noted that a confined environment aboard the MV Hondius means that passengers and crew may still be within the virus’s incubation period.

The scientists thus warned, "A negative PCR test shortly after exposure does not necessarily rule out future infection.” They recommend “ongoing monitoring, repeat testing where necessary, and antibody testing for close contacts”.

Experts are also examining whether transmission could occur during early or minimally symptomatic stages, rather than only after obvious illness begins.

While thalassemia is known widely as a blood disorder, its impact can extend far beyond anemia and transfusions, said experts on World Thalassemia Day today.

World Thalassemia Day is observed every year on May 8 to raise awareness about the inherited blood disorder caused by faulty genes.

The disorder, which often requires blood transfusions every fortnight, affects approximately 1.3 million people living with severe forms of thalassemia worldwide. About 1.5 percent of the global population is carriers, and the disease claims nearly 11,000 lives annually.

Speaking to HealthandMe, health experts raised concerns about the growing mental health and neurological challenges faced by patients, especially children and young adults living with the condition.

Dr. Praveen Gupta, Chairman – Marengo Asia International Institute of Neuro & Spine (MAIINS), Gurugram, shared that repeated blood transfusions are important and save the lives of thalassemia patients, but long-term transfusion therapy can potentially lead to neurological complications if not properly monitored.

“Chronic transfusions can cause iron overload, which is the accumulation of iron in critical organs such as the brain, and may impact cognitive and psychological function, as well as mood,” Dr. Gupta explained.

He added that "changes in oxygen supply and related complications may make patients more vulnerable to headaches, lethargy, or even undetected brain injury".

However, experts stress that most neurological complications can be prevented through multidisciplinary care, iron chelation therapy, and regular monitoring.

Can Thalassemia Affect Brain Development in Children?

The expert stated that thalassemia may also indirectly affect brain development in children, particularly when severe anemia continues for long periods and limits oxygen supply to the growing brain.

Dr. Gupta noted that poor oxygenation, nutritional deficiencies, iron overload from repeated transfusions, and metabolic complications may affect:

• Cognitive function
• Learning ability
• Attention span
• Overall neurodevelopment
• Early warning signs may include:
• Delayed speech
• Difficulty concentrating
• Poor school performance
• Frequent headaches
• Irritability
• Developmental delays

Also read: World Thalassemia Day 2026: Why Screening Before Marriage Or Pregnancy Is Important

Early Signs Parents Should Not Ignore

Dr. Vipin Khandelwal, Sr. Consultant Paediatric Haemato Oncology & BMT at Apollo Hospitals Navi Mumbai, told HealthandMe that thalassemia affects the blood’s ability to carry oxygen, and prolonged disruption can impact growth, immunity, bone health, and learning abilities.

“The early signs of thalassemia are often subtle, which is why many families miss them until anemia becomes severe,” he said.

Parents should watch for persistent symptoms such as:

• Unusual tiredness
• Pale appearance
• Poor appetite
• Difficulty gaining weight
• Delayed growth
• Delayed walking or speech
• Reduced stamina
• Bone pain
• Recurrent weakness

He stressed that while thalassemia is inherited, many serious complications can be prevented with early diagnosis, regular check-ups, timely transfusions, and proper iron monitoring.

Why Depression and Anxiety Are Common Among Thalassemics?

Read More: Hantavirus Updates Of The Day: 8 May 2026 - US CDC Classifies Outbreak As 'Level 3' Emergency

Further, the experts also highlighted risk of anxiety, stress, low self-esteem, and depression among people with thalassemia who face lifelong blood transfusions, frequent hospital visits, leading to physical fatigue, and fear of complications. Over time, these challenges may increase, many often go unnoticed or untreated.

Dr. Roshan Dikshit, Senior Consultant, Haematology & Bone Marrow Transplant at Aakash Healthcare, told HealthandMe that thalassemia is not only a physical health condition, but also an emotional and psychological challenge. He stressed the need to provide mental support to thalassemic patients.

“Frequent hospital visits, lifelong blood transfusions, fear of complications, and social limitations can increase the risk of anxiety, stress, and depression, especially among teenagers and young adults,” said Dr. Roshan Dikshit, Senior Consultant, Haematology & Bone Marrow Transplant at Aakash Healthcare.

According to Dr. Dikshit, many patients struggle with:

• Low self-esteem
• Isolation
• Emotional fatigue.

Importantly, these emotional challenges often go unnoticed.

“Mental health support should be considered an essential part of thalassemia care. Counseling, family support, social acceptance, and open communication can significantly improve a patient’s emotional well-being and quality of life,” he said.

He also emphasized that early psychological intervention can help patients cope better with the disease and reduce the long-term mental health burden associated with chronic illness.