Malmo: Adults with diabetes could benefit from better treatment if the condition was categorized into five types, rather than just two. This is the conclusion of a new study published in The Lancet Diabetes & Endocrinology.
Researchers say that diabetes should be categorized into five types, rather than two. 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.
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. As part of the analysis, the scientists looked at six measures in each subject that each represents 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.
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. the researchers indicate that the current classifications of diabetes fail to target the underlying features of the disease
“Existing treatment guidelines,” concludes Prof. Groop, “are limited by the fact they respond to poor metabolic control when it has developed, but do not have the means to predict which patients will need intensified treatment. This study moves us towards a more clinically useful diagnosis, and represents an important step towards precision medicine in diabetes.”