Last updated March 15, 2018 at 10:17 am
Researchers propose five new categories for adult-onset diabetes.
Diabetes is currently categorised as type 1 or type 2. Type 2 diabetes is also known as adult-onset diabetes. But researchers now say that type 2 diabetes can be further categorised into five distinct variations.
The majority of patients with diabetes (75-85%) have type 2. But current treatment plans usually fail to stop progression of the disease and prevent chronic complications.
Redefining type 2 diabetes
The new analysis identifies five different groups, or clusters, of patients with different characteristics and risk profiles for complications.
These types of diabetes were distinct, and included three severe and two mild forms of the disease.
- Cluster 1 = severe autoimmune diabetes (6-15% of patients)
- Cluster 2 = severe insulin-deficient diabetes (9-20% of patients)
- Cluster 3 = severe insulin-resistant diabetes (11-17% of patients)
- Cluster 4 = mild obesity-related diabetes (18-23% of patients)
- Cluster 5 = mild age-related diabetes (39-47% of patients)
Those in cluster 3 – the most resistant to insulin – had a higher risk of diabetic kidney disease than clusters 4 and 5, even though they had all been prescribed similar treatment.
Cluster 2 had the highest risk of retinopathy (retina damage).
All five types of diabetes were also genetically distinct, which supports the idea that the five types are not simply different stages of the same disease.
The study was replicated in four independent cohorts, totalling 14,775 patients with newly diagnosed diabetes across Sweden and Finland.
The analysis was based on six variables which are typically already measured at diagnosis: age at diagnosis, body mass index (BMI), long-term glycaemic control (HbA1c), successful functioning of the insulin-producing cells in the pancreas, insulin resistance, and presence of auto-antibodies associated with autoimmune diabetes.
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.
Personalised treatment with better outcomes
These definitions highlight a need to personalise treatment for diabetics and identify those at risk of certain complications compared to other diabetic types.
“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,” says lead author of the study Professor Leif Groop, Lund University Diabetes Centre (LUDC), Sweden, and Institute for Molecular Medicine Finland (FIMM).
“This study moves us towards a more clinically useful diagnosis, and represents an important step towards precision medicine in diabetes.”
The research is published in The Lancet Diabetes & Endocrinology. A comment piece was also published in The Lancet Diabetes & Endocrinology.
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