May 26, 2018

Five Distinct Subgroups of Patients With Diabetes Identified

04 March 2018, 02:00 | Franklin Nunez

Researchers propose 5 distinct types of adult-onset diabetes

There is often confusion between MODY and Type 1 Diabetes as both are found to affect young people or children. Type 1 Diabetes is diagnosed in those suffering from MODY leading to misdiagnosis

"Diabetes is actually five separate diseases", reports BBC News on a study looking at almost 9,000 people with diabetes in Sweden and Finland.

They said a refined classification could provide a powerful tool to individualise treatment and identify individuals with increased risk of complications at diagnosis, such as nerve damage, cardio vascular disease or skin conditions.

By isolating measurements of insulin resistence, insulin secretion, blood sugar levels, age, and the onset of illness, they distinguished five distinct clusters of the disease - three serious and two milder forms. "These included the age of diagnosis, body mass index, long-term glycaemic control, successful functioning of the insulin-producing cells in the pancreas, insulin resistance and presence of auto-antibodies associated with autoimmune diabetes".

By analysing 13,270 diabetics, . the study identified three... Genetic analysis of the five subgroups revealed that all of them are genetically distinct from one another, but it is not clear from the study if there are different causes or if patients can change type over time.

People with type 1 diabetes, as we traditionally understand it, have an immune system that attacks and destroys the cells that make insulin, rendering them permanently insulin-deficient.

The researchers at Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland examined 14,775 patients and their blood, conducting detailed analyses.

Breaking popular perceptions about there being only two types of Diabetes - Type I which onsets in childhood and Type II which is more of a lifestyle disorder - a study by medical journal The Lancet has gone on to say that there are at least five types of adult diabetes.

Those in cluster 3 (most resistant to insulin) had a significantly higher risk of diabetic kidney disease than people in clusters 4 and 5 but had been prescribed similar diabetes treatment.

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"Meanwhile, there are many drugs available for controlling blood sugar levels". This group had a low proportion of patients taking metformin, although the authors say they would be expected to benefit the most from the drug.

Cluster 5: Mild diabetes among mostly older patients, accounting for 34 to 47% of cases.

The first cluster - defined as severe autoimmune diabetes - was the least common, with only 6.4% of the cohort fitting this type. Further research is needed to see whether these 5 clusters hold true for non-Scandinavian populations.

Dr. Victoria Salem, a consultant and clinical scientist at Imperial College London, told the BBC that the study was a step forward for diabetes treatment but that it wouldn't lead to a change in practice just yet.

Cluster 4 are the patients with mild, obesity-related diabetes who are closer to those in cluster 3 in terms of insulin production. "For example, whether we'd find the same subtypes in people of different ethnicity or nationality". "A more accurate diagnosis can be made by also considering the factors accounted for in ANDIS (All New Diabetics In Skåne)".

Patients within each cluster demonstrated different kinds of health risks.

They believe that the study might help tailor and target treatment and lay the foundation for precision medicine in the future.

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