Diabetes 'consists of 5 distinct types'

Simon Moss
March 4, 2018

There are five distinct types of diabetes that can occur in adulthood, rather than the two now recognised, they reported in The Lancet Diabetes & Endocrinology, a leading medical journal. Groop said the existing guidelines can not differentiate between patients who will need intensified treatment and those who will not.

Based on these criteria, between 75% and 85% of people with diabetes are classified with type 2, the authors wrote in their paper.

Diabetes is a more diverse disease than medicine now acknowledges - and treatments could be improved by splitting the disease into more types, according to a new study.

Type 1 diabetes affects the immune system, wherein the body's insulin making cells are attacked, leading to less control of blood sugar levels. "This supports the idea that the five types of diabetes are not simply different stages of the same disease", a researcher said. Researchers replicated the findings in three further independent cohorts: the Scania Diabetes Registry (n = 1,466), All New Diabetics in Uppsala (n = 844) and Diabetes Registry Vaasa (n = 3,485).

"O$3 ur data suggest that the combined information from a few variables central to the development of diabetes is superior to measurement of only one metabolite, glucose", Ahlqvist said. Clustering was replicated across the remaining three cohorts.

The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters. Clinical characteristics included early-onset of the disease and being GADA positive, along with a lower BMI, poor metabolic control, and insulin deficiency.

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Another group facing serious complications was composed of relatively young, insulin-deficient patients. Researchers used Cox regression and logistic regression analyses to compare time to medication, time to reaching the treatment goal and risk for diabetic complications across clusters, as well as genetic associations.

The third cluster made up 15.3 percent of the whole cohort of participants.

Type one diabetes is an autoimmune condition that prevents the pancreas from producing insulin, whilst type two is often referred to as a lifestyle related condition, commonly triggered by obesity.

Type 1 diabetes, which is a serious lifelong condition that typically requires insulin injections or pump, can develop quickly over a matter of weeks, even days.

Cluster 2 had a higher risk of blindness while cluster 3 had the greatest risk of kidney disease, so some clusters may benefit from enhanced screening. He also added that future studies should investigate the effects of age on diabetes in patients. Last night, research bodies welcomed the new study, but stressed more examination of the drug's effects was still needed.

The scientists from Lund University Diabetes Centre and Skåne University Hospital in Malmö, Sweden, and the Institute for Molecular Medicine, Helsinki, Finland, analysed 5 studies involving 14,775 adults from Sweden and Finland who had recently been diagnosed with diabetes. The clusters and associated complications will need to be verified in other populations, including other ethnicities that may have a different risk of diabetes, such as Asian populations.

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