Diabetes falls into five types, not just two

Bryan Strickland
March 4, 2018

"Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment", explained Groop, who initiated the study.

Currently, the disease is divided into two sub-types.

"Five hundred people are diagnosed with type 2 diabetes across the United Kingdom every day; that's the equivalent of one person every three minutes".

"Type 1 diabetes isn't now preventable, but three in five cases of Type 2 diabetes can be prevented or delayed with a healthy lifestyle and better understanding of the condition".

However, other experts also believe that there is still a need for further studies especially since the test was conducted only among 14,775 patients from the Swedish All New Diabetics in Scania when the diabetes risk in different parts of the world vary greatly.

Those in cluster 3 who were most resistant to insulin were found to be significantly more at risk of diabetic kidney disease than those in clusters 4 and 5, despite being prescribed the same treatment. Those in the severely insulin-deficient cluster had the highest risk for diabetic retinopathy.

"This is the first step towards personalised treatment of diabetes", said senior author Leif Groop, an endocrinologist at Lund University in Sweden, adding that the new classification is a "paradigm shift" in how the disease is viewed.

The outcomes, distributed in The Lancet Diabetes and Endocrinology, demonstrated the patients could be separated into five particular groups. The more common form, type 2, is linked to obesity and stops the body from making enough insulin or reacting to its production.

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Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and producing insulin, but their body was no longer responding to it.

Mild diabetes related to obesity mainly observed in people who were very overweight, but closer to the norm than those in cluster 3 in terms of their metabolic system. However, it's not yet clear whether patients can move between clusters over time, and the authors say they can't yet claim that their clustering method is the best classification system for diabetes subtypes.

In addition to a more refined classification, the researchers also discovered that the different groups are more or less at risk of developing various secondary diseases. Most diagnosed cases are type 2 (75-85%). Cluster 5 (n = 3,513) was described as mild, age-related diabetes with older patients but only modest metabolic derangements, according to researchers.

Worldwide, diabetes affects about one in every 11 adults. This suggests that more studies are needed to confirm that the anti-diabetic effects observed are exclusively caused by lefluonamide's effect on the insulin receptor.

The researchers also want similar studies in China and India with people of different ethnic backgrounds.

Dr Emily Burns, head of research communications at Diabetes UK said finding diabetes subtypes could help patients, but that more work was needed.

Improved understanding may allow necessarily treatment to be tailored and help us recognise which patients are more likely to develop complications.

Researchers did not observe between-cluster differences for age- and sex-adjusted coronary event and stroke risk, and no genetic variant was associated with all the clusters.

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