In the study published in The Lancet Diabetes & Endocrinology, scientists suggested treatment decisions should be taken with the new classification
Diabetes may have more classifications than the types 1 and 2 currently known, and precision classification could be the key to the battle between medicine and high blood sugar, suggests new research published in The Lancet Diabetes & Endocrinology journal.
The study, by researchers from Lund University Diabetes Centre (LUDC), Sweden, and Institute for Molecular Medicine Finland (FIMM) separated adult-onset diabetes cases into five different types to help better tailor early treatment for patients. The five types of the disease found in the study had different characteristics and were associated with different complications, illustrating the varied treatment needs of patients with diabetes.
The authors identified one autoimmune type of diabetes (condition in which the body produced chemicals that destroyed insulin) and four distinct subtypes of type 2 diabetes – three severe and two mild forms of the disease. Among the severe forms, there was one group with severe insulin resistance and a significantly higher risk of kidney disease than the other types (affecting 11-17% of patients), and a group of relatively young, insulin-deficient individuals with poor metabolic control but no auto-antibodies (9-20%).
The other severe group were insulin-deficient patients who had auto-antibodies associated with autoimmune diabetes (6-15%), a form of diabetes formerly called type 1 diabetes, or latent autoimmune diabetes in adults (LADA).
The most common form of the disease was one of the more moderate forms of diabetes, which was seen in elderly people and affected 39-47% of patients. The other mild form of diabetes was mainly seen in obese individuals and affected 18-23% of patients.
All five types of diabetes were also genetically distinct. According to WHO estimates, India has about 70 million diabetics and the country is rapidly moving towards the dubious distinction of becoming the diabetes capital of the world even though the rates of the disease are increasing across the world. While type 1 diabetes is generally diagnosed in childhood and caused by the body not producing enough insulin, type 2 diabetes occurs when the body cannot produce enough insulin to meet the increased demands imposed by obesity and insulin resistance (dearth of hormone receptors), and typically occurs later in life. Most diagnosed cases of diabetes are type 2 (75-85%).
Future research will be needed to test and refine the five types of the disease by including biomarkers, genotypes, genetic risk scores, blood pressure and blood lipids.
“Evidence suggests that early treatment for diabetes is crucial to prevent life-shortening complications. More accurately diagnosing diabetes could give us valuable insights into how it will develop over time, allowing us to predict and treat complications before they develop. Existing treatment guidelines 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,” said lead author of the study Professor Leif Groop, Lund University Diabetes Centre (LUDC), Sweden.
