Diabetes falls into five types, not just two

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Researchers in Scandinavia have proposed classifying diabetes as five types of disease, rather than two types, according to a new study.

Researchers identified genetically marked groupings of the disease that vary by severity, age at which they most often occur and probable complications.

"Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment", explained Groop, who initiated the study.

Until now diabetes has traditionally been split into two "types".

Group 1, the severe autoimmune diabetes, essentially corresponds to Type-1 diabetes and is characterised by onset at young age, poor metabolic control and impaired insulin production.

Severe insulin-resistant diabetes patients, generally overweight and producing insulin, which their body was no longer responsive to.

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After analyzing the measures in a cohort of 8980 adults at first, researchers identified 1 autoimmune type of diabetes and 4 distinct subtypes of type 2 diabetes, which were then tests across 3 more cohorts of 5795 people: the Scania Diabetes Registry (n=1466), All New Diabetics in Uppsala (n=844) and Diabetes Registry Vaasa (n=3485).

Diabetes affects about one in 11 adults worldwide and increases the risk of heart attack, stroke, blindness, kidney failure and limb amputation.

Ahlqvist's group noted that a web-based classification tool is now under development. Diabetic ketoacidosis was more frequent in clusters 1 and 2, whereas cluster 3 had the highest prevalence of nonalcoholic fatty liver disease.

The five types of diabetes each had different characteristics and were associated with different complications, illustrating the varied treatment needs of patients with diabetes, they add.

The scientists found one autoimmune type of diabetes - a condition in which the body produces chemicals that destroy insulin.

The second cluster was patients who showed insulin deficiency and were GADA negative.

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(Other, secondary types of diabetes can involve insulin or other mechanisms).

The third cluster made up 15.3 percent of the whole cohort of participants.

Additionally, the findings concluded that the different subgroups are more or less at risk of developing various secondary disease.

The study, by Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland, looked at 14,775 patients including a detailed analysis of their blood. This group had relatively low use of metformin, despite the authors noting that this group would likely see the most benefit from such treatment.

Group 2, SIDD (severe insulin-deficient diabetes): includes individuals with high HbA1C, impaired insulin secretion and moderate insulin resistance.

Rob Sladek, MD, of McGill University, Montral, wrote an accompanying editorial with this landmark paper.

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They said it would be particularly suitable for patients with both diabetes and rheumatoid arthritis. In it, they created five categories of diabetes instead of two. Last night, research bodies welcomed the new study, but stressed more examination of the drug's effects was still needed. He mentioned a caveat saying that this study cohort was a uniform Scandinavian population and thus all races and ethnicities were not adequately represented.

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