Researchers say that diabetes should be categorized into five types, rather than two.


eMediNexus    03 March 2018

The research was led by Prof. Leif Groop, of the Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland in Helsinki.

Excluding gestational diabetes — diabetes that develops during pregnancy — there are two main types: type 1 and type 2.

In type 1 diabetes, the beta cells of the pancreas — which produce insulin, the hormone that regulates blood sugar levels — are mistakingly attacked and destroyed by the immune system.

Type 2 diabetes is the most common form, accounting for around 90–95 percent of all cases. This occurs when the bodys cells stop responding to insulin, or the beta cells are unable to produce sufficient amounts of the hormone.

The heterogeneity of diabetes

The presence of such autoantibodies is an indicator of type 1 diabetes. If a person does not have these autoantibodies, they are considered to have type 2 diabetes.

But, as Prof. Groop and colleagues note, the classification guidelines for diabetes have not been updated for 20 years — despite increasing evidence that diabetes has high heterogeneity.

Prof. Groop and his team say that a "refined classification" of diabetes based on its heterogeneity could help healthcare professionals better predict which individuals are most likely to develop complications and allow a more personalized approach to treatment.

In their study, the researchers propose that diabetes should no longer be categorized as two types. Instead, they say that the condition should be classified into five distinct types.

The researchers came to their proposal by analyzing the data of four study cohorts. These included a total of 14,775 adults from Sweden and Finland, all of whom had been newly diagnosed with diabetes.

As part of the analysis, the scientists looked at six measures in each subject that each represent different features of diabetes.

These measures were: body mass index (BMI); age at diabetes diagnosis; hemoglobin A1C (HbA1C), a measure of long-term blood sugar control; beta cell functioning; insulin resistance; and the presence of diabetes-related autoantibodies.

As well as conducting genetic analyses of the participants, the researchers also compared their disease progression, complications, and treatment.

The study revealed five distinct forms of diabetes, three of which were severe and two that were mild. The team categorized these as follows:Cluster 1: severe autoimmune diabetes (currently known as type 1 diabetes), characterized by insulin deficiency and the presence of autoantibodies. This was identified in 6–15 percent of subjects.Cluster 2: severe insulin-deficient diabetes, characterized by younger age, insulin deficiency, and poor metabolic control, but no autoantibodies. This was identified in 9–20 percent of subjects.Cluster 3: severe insulin-resistant diabetes, characterized by severe insulin resistance and a significantly higher risk of kidney disease. This was identified in 11–17 percent of subjects.Cluster 4: mild obesity-related diabetes, most common in obese individuals. This affected 18–23 percent of subjects.Cluster 5: mild age-related diabetes, most common in elderly individuals. This was the most common form, affecting 39–47 percent of subjects.

The researchers note that each of these five types "were also genetically distinct," meaning that there were no genetic mutations that were shared across all five clusters.Just 42 percent of patients in cluster 1 and 29 percent of patients in cluster 2 received insulin therapy from the point of disease onset. [Medicalnewstoday]

[The Lancet Diabetes & Endocrinology.]

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