Study Identifies Five Types of Diabetes, Not Just Two

From TIME - March 2, 2018

For many years, diabetes cases have largely been classified as either type 1 or type 2. But a new study suggests that there may actually be five different types of the diseasesome of which may be more dangerous than others. A new classification system could help doctors identify the people most at risk for complications, the study authors say, and could pave the way for more personalized and effective treatments.

The research article, published in The Lancet: Diabetes & Endocrinology, calls attention to the need for an updated diabetes classification system. The current system has not been much updated during the past 20 years, the authors wrote in their paper, and very few attempts have been made to explore heterogeneity of type 2 diabetesdespite calls from expert groups over the years to do so.

Meanwhile, they wrote, diabetes is the fastest-increasing disease worldwide, and existing treatments have been unable to stem the tide or prevent the development of chronic complications in many patients. One explanation, they say, is that diabetes diagnosis is based on only one measurementhow the body metabolizes glucosewhen the disease is actually much more complex, and much more individual.

Currently, diabetes is classified based mainly on age of diagnosis (younger people often have type 1) and on the presence or absence of antibodies that attack beta cells, which release insulin. People with type 1 diabetes have these antibodiesand therefore cannot make insulin on their ownwhile people with type 2 do not. Their bodies make insulin but dont use it the right way.

Based on these criteria, between 75% and 85% of people with diabetes are classified with type 2, the authors wrote in their paper. A third subgroup of diabetes, known as latent autoimmune diabetes in adults (LADA), has also been discussed in recent research.

But the study authors, from the University of Gothenberg and Lund University in Sweden, say additional subgroups are needed. To demonstrate their argument, they analyzed health data from nearly 15,000 Swedish people with type 2 diabetes, focusing on six variables that had been measured and recorded at the time of their diagnosis: age, body mass index, the presence of beta-cell antibodies, level of metabolic control and measures of beta-cell function and insulin resistance.


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