A newly suggested reclassification of diabetes into five instead of two types shows promise as a more effective and personalised treatment option for people with diabetes.
Diabetes refers to people whose blood sugar (glucose) levels are too high and this disease is on the increase, with an estimated 425 million people around the world having diabetes.
Historically type 1 diabetes refers to people unable to produce insulin, and type 2 refers to people whose bodies produce insulin, but don’t use it as intended. Insulin is a blood sugar lowering hormone.
A recent Scandinavian study by researchers from the University of Gothenberg and Lund University in Sweden has analyzed data from about 15 000 Swedish people with type 2 diabetes, focusing on variables such as age at diagnosis; body mass index; insulin secretion, blood sugar levels; and insulin resistance.
This study identified five new subgroups of the disease, with different characteristics. The results promise that a refined classification system could assist in identifying people with an increased risk of complications right at the point of diagnosis; and guide doctors in selecting an individualised treatment for patients (instead of the current “one size fits all” approach to the treatment of Type 2 diabetes).
The suggested five subgroups (clusters) of diabetes are:
- Cluster 1: Called “severe autoimmune diabetes”, the onset of this severe form of diabetes is usually at a young age, and is characterized by an autoimmune (immune system) disease that prevents the body from producing insulin. These patients are usually not overweight. This was previously referred to as type I diabetes (6,4 % of patients)
Researchers believe that type II diabetes encompasses four kinds of diabetes, each affecting different age groups and carrying different threats.
- Cluster 2: Called “severe insulin-deficient diabetes”, the onset of this severe form of diabetes is also usually at a young age, also not overweight, and is characterized by the body not producing enough insulin, probably due to a deficiency in the beta cells in the pancreas that produce insulin. These people have a high risk of retinopathy that can lead to loss of vision (17,5% of patients)
- Cluster 3: Called “severe insulin-resistant diabetes”, it usually occurs in overweight people whose bodies produce insulin, but their cells are not responding to it (insulin resistance). These people have the highest risk of liver and kidney disease resulting from this severe form of diabetes (15,3 % of patients)
- Cluster 4: Called “mild obesity-related diabetes” usually occurs in obese people and it is a milder form of Cluster 3, with less metabolic problems (6% of patients). Responds to lifestyle changes
- Cluster 5: Called “mild age-related diabetes”, it is similar to Cluster 4, but with the onset of diabetes at a higher age. This is the most common form of diabetes (39,1% of patients). Responds to lifestyle changes
In addition to these clusters of diabetes, recent studies have described Alzheimer’s disease as a type of diabetes, often referred to as type 3 diabetes, with research linking the risk of Alzheimer’s to high blood sugar levels. Higher blood sugar levels may mean more severe levels of Alzheimer’s.
Dissecting brain tissue from recently diseased Alzheimer’s patients has revealed poor reaction to the blood sugar lowering hormone insulin. This is further significant in the sense that insulin is needed to store memories in the brain.
Sources:
Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Emma Ahigvist PhD, et al. Study published 1 March 2018 in The Lancet Diabetes & Endocrinology.
New study: Five types of diabetes. Published 13 March 2018. Food Pharmacy.
The 5 “new” types of diabetes, explained. Published 2 March 2018. Live Science.
Researchers identify five different types of diabetes, not just Type 1 and Type 2. Published 2 March 2018. TIME Health.
There are five types of diabetes not two, say scientists. Published 3 March 2018. P.4. The Times. (London).
New study confirms: Alzheimer’s disease may be a form of diabetes. Published 14 November 2017. Food Pharmacy.
HEALTH INSIGHT. APRIL 2018.
