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.

When discussing patient safety in chronic disease management, conversations often focus on drug safety profiles, accurate dosing, and acute complication prevention. In long-term conditions like diabetes, which affects over 100 million people in India, patient safety extends far beyond the medicine. It lies at the intersection of patient education, reliable delivery systems, continuous monitoring, and structured medical guidance.

For instance, the recent evolution in diabetes therapies, such as the shift from 365 daily basal insulin injections a year to just 52 once-weekly administrations, marks a major turning point in chronic care. Reducing injection frequency addresses therapeutic fatigue and needle anxiety, factors that have historically delayed necessary insulin initiation by several years in India. As advanced delivery systems make administration simpler, ensuring that the patient continues long-term treatment is a key requirement for chronic care.

This is where a comprehensive system becomes critical. An advanced delivery device or once-weekly formulation is an enabler. As an intuitive delivery system, it offers accurate dosing and convenience, but cannot interpret fluctuating blood glucose trends, adjust for lifestyle changes, or recognize early warning signs of hypoglycaemia on its own. Long-term patient safety views advanced delivery as an integral link of a broader patient-care framework, which includes:

Also read: Ozempic, Wegovy & PMOS: How GLP-1 Drugs Are Changing PMOS Treatment?

Education as the primary step

Patient safety begins with health literacy. Understanding dose titration, storage conditions, hypoglycaemia protocols, and blood glucose monitoring transforms a patient from a passive recipient into an empowered manager of their health.

Reliability in delivery

Delivery mechanisms, whether daily smart pens or weekly formulations, must deliver predictable, mechanical accuracy. Reliable delivery builds patient confidence, minimizes dosing errors, and alleviates administration anxiety.

Continuous follow-ups

Diabetes is a progressive, dynamic condition. While delivery devices ensure precise administration, continuous engagement with healthcare professionals ensures that treatment regimens adapt to ageing, comorbidities, and lifestyle changes over time. In many cases, technology evolves in response to the pain points shared by the patient.

As the world marks World Patient Safety Day, the focus must expand beyond modernizing treatment delivery to strengthening the entire system surrounding the patient. Innovations in drug delivery are major milestones, but their real-world safety and effectiveness depend entirely on the educational and clinical scaffolding supporting them.

Grounding modern delivery solutions in patient education and clinical continuity creates a model where diabetes care is not only less burdensome, but safe for a lifetime.

Heart disease is now the leading cause of death among Hispanic adults in the US, overtaking cancer, according to a new report from the American Heart Association (AHA).

The report, published in Circulation, says that several cardiovascular risk factors are appearing at younger ages among Hispanic adults, setting the stage for heart disease and stroke earlier in life.

But the AHA says there is no single explanation, or even a single “Hispanic” health profile. Risk varies substantially among Mexican, Puerto Rican, Cuban, Dominican, Central American and South American communities, as well as between people born in the US and those born elsewhere.

Diabetes, Obesity And High BP Showing Up Earlier

The report identifies obesity, Type 2 diabetes and high blood pressure as major contributors to cardiovascular risk.

Nearly 46% of Hispanic adults have obesity, while Type 2 diabetes affects about 15.5%, almost twice the prevalence seen among non-Hispanic White adults. Around 44% have high blood pressure, but awareness, treatment and control remain lower than they should be.

These disorders can damage blood vessels over time. High blood pressure places continuous stress on artery walls. Diabetes can damage blood vessels and nerves and accelerate atherosclerosis, while excess body weight is linked to both hypertension and metabolic disease.

The consequences can appear earlier than expected. Hispanic adults are diagnosed with heart failure around 8 to 9 years earlier than White adults, while their first stroke occurs, on average, 6 to 8 years earlier.

Also read: Cefepime: Antibiotic Used For Pneumonia, UTI Linked To Higher Death Risk In Adults

It Is Not Just About Lifestyle

The AHA report says that cardiovascular disparities cannot be explained simply by individual choices. “Many Hispanic adults face obstacles that extend far beyond the doctor's office,” said Johanna Contreras, MD, MSc, FAHA, chair of the scientific statement's writing group.

“A person's ZIP code, access to healthy foods, ability to communicate with health care providers and opportunities to be physically active can be just as important to heart health as traditional medical risk factors.”

Access to preventive care also plays a key role. While high blood pressure rates are similar to those among non-Hispanic White adults, Hispanic adults are less likely to have their hypertension diagnosed, treated or controlled.

Also read: Eating 4–6 Servings of Whole Grains Daily May Lower Heart Disease Risk

Sleep, Diet And Physical Activity Add To The Risk

Nearly one-third of Hispanic adults report getting less than seven hours of sleep, while around one-third report no moderate-to-vigorous leisure-time physical activity. Dietary quality is another concern, with very few meeting recommended targets for sodium and healthy-fat intake.

Obesity affects almost half of Hispanic adults, with particularly high rates among people of Puerto Rican and Dominican heritage.

Type 2 diabetes is most prevalent among Mexican and Puerto Rican adults, while hypertension is particularly common among Puerto Rican, Cuban and Dominican populations.

Risk factors, healthcare access, language, income, cultural practices and immigration experiences can differ significantly between Hispanic communities.

The AHA is therefore calling for culturally tailored prevention, better representation of Hispanic people in cardiovascular research and more detailed health data that does not treat all Hispanic populations as one group.

When it comes to high blood pressure, blood sugar, cholesterol, weight, physical activity, diet and sleep, it is important to act early for prevention. AHA says prevention may need to begin earlier in life, rather than waiting for cardiovascular diseases.

CFor years, polycystic ovary syndrome (PMOS) has been characterised with irregular periods, excess hair growth, infertility, and weight gain. But doctors have increasingly been emphasising that it is a far more complex condition.

With metabolic conditions like insulin resistance, dyslipidaemia, fatty liver, and increased risk of diabetes forming an important part of the diagnosis, the condition has been rightly re-termed as Polyendocrine Metabolic Ovarian Syndrome (PMOS).

When the metabolic symptoms of PMOS came into focus, a a newer class of medicines, GLP-1 receptor agonists like semaglutide, began attracting attention.

Drugs like Ozempic and Wegovy were developed primarily for diabetes and obesity, not as universal treatments for PMOS.

Yet their ability to help lose weight and improve metabolic health has raised an important question: are GLP-1 drugs actually changing how doctors treat PMOS, or are they simply becoming another tool for managing obesity and insulin resistance in women who also have PMOS? According to experts, the answer is not that simple.

As September is PMOS Awareness Month, we take a closer look at how GLP-1 weight loss drugs are changing PMOS treatment.

GLP-1 Drugs Target The Metabolic Side of PMOS

HealthandMe spoke to Dr. David Chandy, Director of the Department of Endocrinology and Diabetology at Sir H. N. Reliance Foundation Hospital, Mumbai, who said that PMOS does not present identically in every woman.

“GLP-1 drugs are changing the treatment of the metabolic component of PMOS, rather than becoming a treatment for every aspect of PMOS. PMOS is not a disease with one presentation. Some women are lean, some have significant obesity, some predominantly have menstrual irregularity or excess hair growth, while others have marked insulin resistance, prediabetes or diabetes.”

Talking to HealthandMe, Dr. Sujith Ash, Consultant Obstetrician and Gynecologist at P. D. Hinduja Hospital & Medical Research Centre, Khar West, Mumbai, similarly stressed that PMOS needs to be understood as a broader metabolic and reproductive condition.

“What you first need to understand is whenever we are thinking about PMOS, it is a huge umbrella under which a lot of organs are implicated. So, it is not just the period-related issues that we are dealing with, we are also dealing with liver implications where your metabolism is affected, memory and exhaustion, and insulin resistance.”

Dr. Trupti Prasad, Endocrinologist at LH Hiranandani Hospital, told HealthandMe that the shift in understanding PMOS as a metabolic disorder is important when considering GLP-1 drugs.

She said, “As we know, there is a change in the name of PMOS to PMOS. It's now more considered as a metabolic disorder rather than just focusing on the ovaries and reproductive functions.”

She added that insulin resistance is one of the central mechanisms involved in PMOS and can have consequences beyond reproductive health.

“GLPs are definitely one of the main core pathology, pathophysiology of PMOS is the insulin resistance. So one of the main mechanisms by which GLP would help here is insulin resistance and weight reduction. But insulin resistance comes with complications like dyslipidemia, cholesterol disorders and even fatty liver.”

Also read: Weight Loss Surgery May Improve Irregular Periods And Other PMOS Symptoms

Having PMOS Does Not Automatically Mean You Need Ozempic Or Wegovy

One of the biggest concerns surrounding GLP-1 drugs is the perception that a woman with PMOS and excess weight should automatically be prescribed one. Experts warn against this strategy of treatment.

“Having PMOS alone is not an indication to start a GLP-1 drug.” Chandy said. “The first question should be whether the woman has overweight or obesity significant enough to justify medical treatment according to accepted obesity-treatment criteria.”

He said GLP-1 treatment becomes more relevant when excess weight is accompanied by metabolic complications.

“I would particularly consider it when there is significant excess weight or central obesity with problems like insulin resistance, prediabetes, type 2 diabetes, fatty liver, dyslipidaemia or other weight-related complications, especially when lifestyle measures alone have not achieved sufficient results.”

Conversely, she said a woman with lean PMOS or someone seeking to lose a small amount of weight for cosmetic reasons should not automatically be placed on semaglutide.

Prasad said doctors also use BMI and the presence of metabolic complications when considering these medications.

She also noted that Indian thresholds can differ from Western obesity criteria because metabolic diseases can occur at lower BMI levels in Indian populations.

“We use a cut-off of 25 with one comorbidity or above a 27 BMI irrespective of comorbidity. So the patient with this criteria of a BMI of 25 and has a PMOS obviously would go for the GLP-based therapies.”

Ash said assessment should go beyond weight alone. He says, “The other thing would be insulin resistance. We ask for a fasting insulin level in these patients along with the sugars and the cholesterol and the lipid profile basically, your fasting blood sugar, your HbA1c.”

Also read: Thin Outside, Fat Inside: Why A Slim Body May Still Hide Metabolic Health Risks?

Effects Of GLP-1 Drugs On Other Symptoms Of PMOS

Weight loss is currently the most established effect of GLP-1 drugs in this context. But researchers and clinicians are also interested in whether the improvement in metabolic health can translate into changes in other features of PMOS.

Dr. Chandy said the evidence is strongest for metabolic outcomes like weight reduction and insulin resistance. There are also signals of reproductive benefits, although the evidence is not equally strong for every outcome.

Dr. Chandy said, “There is encouraging evidence that menstrual cycles may become more regular. Some studies show improvements in sex hormone-binding globulin and modest reductions in androgen levels.”

However, he cautioned against treating these findings as established evidence that GLP-1 drugs directly treat every manifestation of PMOS. He added, “The effects on hyperandrogenism are inconsistent, and we do not yet have sufficiently strong evidence to say that GLP-1 drugs are treatments for hirsutism or acne.”

Dr. Ash explained why improving insulin resistance could have effects that extend beyond body weight. He said, “When I'm looking into the insulin resistance picture of PMOS, the major effect in the patient is not just the weight. It is the insulin that leads to the androgenic effects.”

He said insulin resistance can contribute to menstrual abnormalities and other symptoms. According to Dr. Ash, improving insulin sensitivity can reduce hyperinsulinaemia and potentially influence androgen levels and menstrual regularity.

“When GLPs are introduced in your body, GLPs will improve the insulin sensitivity. And once the hyperinsulinemia reduces, then that will help in suppressing the appetite. So, then weight balancing is better. Also, with the insulin resistance becoming better, the androgenic levels or the male hormone levels, which are increased in PMOS, PMOS, that is also better.”

Also read: From Insulin Resistance to Fertility: Understanding the Metabolic Side of PCOS

GLP-1 Drugs Vs Metformin

Metformin has long been used in PMOS treatment, particularly when insulin resistance and metabolic abnormalities need to be addressed. The arrival of GLP-1 drugs has therefore raised the question of whether they could eventually replace the older drug. Experts say that is not how the comparison should currently be viewed.

Dr. Chandy said both drugs are meant for different conditions. Metformin has decades of clinical use behind it, while GLP-1 drugs generally produce substantially greater weight loss.

The expert said, “Metformin has been used in PMOS for decades. It is inexpensive, we have extensive long-term safety experience, and it remains useful particularly for insulin resistance and metabolic abnormalities. GLP-1 drugs generally produce much greater weight loss than metformin. Therefore, in a woman with PMOS and significant obesity, a GLP-1 drug may have a much larger metabolic impact.”

Prasad similarly said GLP-1 drugs could offer an advantage when significant weight reduction is a major treatment objective. But she said it is too early to conclude that GLP-1 drugs will replace metformin.

Dr. Ash highlighted the fact that there is a depth of long-term evidence. He said, “The only deciding factor is that the effects are quicker in GLPs, but it is not something that I can do for a long period. Whereas metformin, I can do it for a longer period. And there are not enough studies which are based around the preconception and pregnancy aspects along with GLPs, which are there with metformin.”

Also read: Meet Louise Brown- The World’s First IVF Baby

Could Better Metabolic Health Improve Fertility?

One of the most intriguing parts of the GLP-1-PMOS conversation is fertility. Some women report that their periods become more regular after losing weight on GLP-1 drugs.

For women whose PMOS is associated with insulin resistance and irregular ovulation, this can improve the hormonal environment needed for ovulation. But experts caution against interpreting this as proof that semaglutide itself is a fertility drug.

Chandy explained that improving insulin resistance can improve reproductive effects. He said, “When a woman with PMOS loses significant weight and insulin resistance improves, insulin levels fall. High insulin levels can stimulate the ovary to produce more androgens and can interfere with normal follicular development and ovulation.”

There may be biological effects of GLP-1 signalling on reproductive issues as well, but Chandy said the clinical significance of these findings remains uncertain.

“There may also be direct effects of GLP-1 signalling on the reproductive system and the ovary, and there is interesting experimental research in this area. But clinically, I think it is premature to say that semaglutide is directly stimulating fertility.”

Women With PMOS Trying To Conceive & GLP-1 Drugs

This is where the difference between improving metabolic health before pregnancy and taking a GLP-1 drug during pregnancy becomes important. Prasad said this preconception can influence pregnancy outcomes.

“Pre-pregnancy parameters are very important in deciding upon what complications arise during the pregnancy. So ideally a normal body weight before pregnancy, even HB1C control should be less than 6.5, normal blood pressure, that is what we look for once a person goes for pregnancy.”

She said GLP-1 treatment can help women before conception, but the medication needs to be stopped before pregnancy. She said, “We have to stop at least two months prior to a planned pregnancy. So current data is not there for use during the pregnancy.”

Chandy similarly said GLP-1 drugs may have a role as a preconception metabolic intervention, rather than a pregnancy or fertility treatment. He also addressed the issue of discontinuing treatment.

Dr. Chandy said, “Another important issue is weight regain. Once GLP-1 therapy is stopped, appetite can increase again and some weight may return. So we need a long-term plan involving nutrition, physical activity and, where appropriate, other metabolic treatments rather than simply stopping the injection and hoping that the benefit remains permanently.”

As GLP-1 drugs become increasingly popular, doctors say one of the biggest risks is reducing a complex condition to a prescription for weight loss. Chandy said PMOS remains a lifelong reproductive and metabolic condition and GLP-1 drugs do not cure it. He also cautioned against viewing GLP-1 drugs as fertility medications. He said for women with PMOS and anovulatory infertility, established fertility treatments remain important.

He said, “The second misconception is that these medicines are fertility drugs. Some women certainly notice more regular periods and may start ovulating after significant weight loss, but that actually means that pregnancy can become possible unexpectedly. Women need to be counselled about contraception because these drugs should not be used during pregnancy.”

Ash said patients also need to understand that medication alone cannot substitute for sustained lifestyle changes.

“The entire idea of using any of the GLPs is that in that few months that we are doing the GLPs, you have to make sure your lifestyle changes even more disciplined, more religious and you follow that lifestyle. So the important part is forming the lifestyle as a habit which will continue for a longer period.”

Prasad stressed that the metabolic component of PMOS requires long-term attention rather than a short course of treatment.

“I want patients to understand that PMOS, as the name suggests, it's a metabolic complication which remains within the person throughout their life. It's not only about the ovaries, not only about the irregular periods or about the infertility issues. It's something which starts maybe like in a young age and it remains with you throughout your life.”