Diabetes has five types, not two

Diabetes has five types, not two

The scientists found one autoimmune type of diabetes - a condition in which the body produces chemicals that destroy insulin.

Initial analysis of the six measures in a cohort of 8980 patient identified one autoimmune type of diabetes and four distinct subtypes of type 2 diabetes, which they then tested across three more cohorts of patients (5795 people).

Gestational diabetes was diabetes associated with pregnancy.

The study can not confirm that the five types of adult-onset diabetes have different causes, nor whether patients' disease type changes over time.

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. Most diagnoses are type 2 (75-85%), and while it's known that type 2 disease is highly variable, few attempts have been made to explore these distinctions.

For the study, researchers monitored 13,270 newly diagnosed diabetes patients ranging in age from 18 to 97. They were hierarchically classified.

"We found that lefluonomide targets a protein involved in desensitising the insulin receptor, which is responsible for instructing the cells to start absorbing sugar from the bloodstream", said Xiulong Xu, Professor at the Institute of Comparative Medicine at Yangzhou University in China. "The only difference was that Group 5 was larger in Finland than in Skane".

Clusters 2 and 3 are both severe forms of diabetes that were "masked within type 2 diabetes", the researchers said.

Severe autoimmune diabetes, broadly similar to type 1 in that it affected patients at a younger age leaving them seemingly unable to produce insulin. These patients had an early onset of the disease and were positive for GADA. Cluster 1 (n = 577) was characterized by early-onset disease, low BMI, poor metabolic control, insulin deficiency and presence of GADA. They had to be prescribed insulin injections for treatment (in 42 percent patients).

But now, a team of scientists in Sweden and Finland have identified five clusters of patients with diabetes. Other clinical characteristics were similar to cluster 1, although this group had the highest proportion of patients on metformin. They were likely to have higher BMIs and were overweight or obese. The researchers noted in their paper that this has come across as a dramatic change in the form of treatment and will affect the quality of life of the patients. However their Metformin use was relatively low.

BRADFORD district has the highest number of people in the United Kingdom suffering from diabetes, according to latest figures. It is a hereditary disease, although it can also be developed without prior family history, and cannot be prevented.

Around a fifth of all participants were classified in cluster 4. TCF7L2 gene mutation further was seen in clusters 2, 4, and 5 and was not seen in cluster 3.

Cluster 2 had the highest risk of retinopathy, which can cause blindness.

The findings could help doctors provide diabetes patients with tailored treatment programs - also called "precision medicine" - and help explain why some patients respond to medications differently.

"In interpreting these results, it is important to consider the effects of age on the prevalence of end-organ damage, particularly for patients with SIRD", Rob Sladek, MD, of McGill University in Montréal wrote in an accompanying editorial. He mentioned a caveat saying that this study cohort was a uniform Scandinavian population and thus all races and ethnicities were not adequately represented.

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