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Five types of diabetes

Study states there should be five types of diabetes

This is the first step towards personalised treatment of diabetes

There should be a reclassification of diabetes that would allow healthcare professionals to predict the risk of serious complications and provide treatment suggestions, according to researchers at Lund University in Sweden, and this would include type 2 diabetes consisting of several subgroups. These are the first outcomes from the All New Diabetics In Scania (ANDIS), a study covering all newly diagnosed diabetics in southern Sweden. The paper, ‘Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables’, was published in The Lancet Diabetes & Endocrinology.

"Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment", said Professor Leif Groop, a physician and professor of diabetes and endocrinology at Lund who initiated the study and believes that the results represent a paradigm shift in how to view the disease in the future. "This is the first step towards personalised treatment of diabetes.”

Diabetes is currently divided into: type 1 diabetes (approx. 10 per cent), type 2 diabetes (85-90 per cent) and a number of less common diseases such as LADA, MODY and secondary diabetes. However, the researchers suggest a new set of subgroups:

  • Group 1: SAID (severe autoimmune diabetes): essentially corresponds to type 1 diabetes and LADA (latent autoimmune diabetes in adults), and is characterised by onset at young age, poor metabolic control, impaired insulin production and the presence of GADA antibodies.
  • Group 2: SIDD (severe insulin-deficient diabetes): includes individuals with high HbA1C, impaired insulin secretion and moderate insulin resistance. Group 2 had the highest incidence of retinopathy.
  • Group 3: SIRD (severe insulin-resistant diabetes): is characterised by obesity and severe insulin resistance. Group 3 had the highest incidence of kidney damage - the secondary disease producing the highest costs to society.
  • Group 4: MOD (mild obesity-related diabetes): includes obese patients who fall ill at a relatively young age.
  • Group 5: MARD (mild age-related diabetes): is the largest group (about 40%) and consists of the most elderly patients.

Approximately 425 million people around the world have diabetes and by 2045, the number is expected to have increased to 629 million. Secondary diseases in the form of kidney failure, retinopathy (eye damage), amputations and cardiovascular diseases result in huge costs to society and major individual suffering. Thus, the need for new and better treatment options is great.

Since 2008, Swedish researchers have monitored 13,720 newly diagnosed patients between the ages 18 and 97. By combining measurements of, for example, insulin resistance, insulin secretion, blood sugar levels (BMI, HbA1c, GADA, HOMA-B and HOMA-IR) and age at onset of illness, the researchers were able to distinguish five distinct clusters that differ from today's classification. 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.

The researchers subsequently repeated the analysis in a further three studies from Sweden and Finland.

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