A study published in the journal The Lancet Diabetes & Endocrinology suggests that diabetes in adults can be treated better if the diabetes is categorized into five types instead of two. This proposal is based on a research study conducted by Prof. Leif Groop at Lund University Diabetes Centre in Sweden in collaboration with the Institute for Molecular Medicine Finland in Helsinki. The research findings are available online and can be viewed by clicking here.
Do you know that only in the United States alone, there are approximately 30.3 million people that are suffering from diabetes? If we exclude the gestational diabetes (diabetes during pregnancy) there are two major types of diabetes called type 1 and type 2.
In type-1 diabetes, beta cells of pthe ancreas are attacked and destroyed by the immune system, mistakenly. These cells produce insulin that regulates blood sugar levels. When these cells are destroyed, the body suffers from a diabetic condition.
In type-2 diabetes, the body cells no more respond to the insulin. Or the beta cells fail to produce sufficient amount of insulin. Type 2 diabetes is the more common form of diabetes that affects more than 90% of all the diabetes cases.
Diverse types of diabetes
The diagnosis for diabetes is made by a test of fasting plasma glucose (FPG) test or the A1C test. Read more about diabetes testing here. The fasting plasma glucose test checks the blood glucose level at a certain time. The A1C test on the other hand measures glucose levels of the previous months too.
When it comes to identifying which type of diabetes a person has, the doctor check for diabetes-related autoantibodies found in the blood. By structure, these are proteins made by the immune system that sometimes attack the own body cells.
When such autoantibodies are present in the body, it indicates that the person is having type 1 diabetes. When these autoantibodies are not present, it means that a person has type 2 diabetes.
In this research, the information on diabetes has been revised and it was found that guidelines for managing diabetes has not been updated for more than 20 years. The incidence of diabetes has been increased but the management plan has not been reconsidered.
Diabetes is not just a disease but a group of chronic metabolic disorders. Diabetes is generally diagnosed by measuring only one blood component. Read more about it by clicking HERE.
In case of an elevation in blood glucose, genetic factors may also impact the circulation of insulin and concentration of insulin. The researchers tell a new and redefined class of diabetes as per its heterogeneity, which makes the healthcare professionals to understand the diabetic complications for future. In this study, the researchers also propose that diabetes should no more be classified in two groups, rather the conditions should be categorized in five ways.
The five types of diabetes
The proposal for categorizing diabetes in five domains is based on the cohort analysis of four studies. The total number of participants overall were approximately 14,775 adults that belong to Sweden and Finland. All these participants were newly diagnosed with diabetes.
For evaluation of diabetes, the researchers investigated six measures in each subject to identify different features of diabetes. The measures included in this study were
- Body mass index or BMI
- Age at diabetes diagnosis
- Hemoglobin A1C (HbA1C)
- Measuring long-term blood sugar control
- Beta cell functioning and insulin resistance
- Presence or absence of diabetes-related autoantibodies
They also studied the genetic analysis of the participants to compare the progression, complication, and treatment of diabetes. As per researcher, diabetes can be categorized into five distinct forms. Three out of five are severe and two are minor.
The new categorization of diabetes is as follows.
- Cluster 1
It represents a severe type of autoimmune diabetes that is called type 1 diabetes. It is diagnosed by insulin deficiency and the presence of autoantibodies in blood. This type of diabetes was identified in 6%–15% of the total subjects.
- Cluster 2
This is a severe insulin-deficient state, which shows up at a younger age. It shows an insulin deficiency, low metabolic control, but the absence of autoantibodies. Among the total participants, this cluster was identified in 9%–20% of subjects.
- Cluster 3
This is a severe insulin-resistant type of diabetes that shows severe insulin resistance. Most of the times it leads to the kidney diseases. From the participants, nearly 11% to 17% had this type of diabetes.
- Cluster 4
This is a minor stage, which is related to diabetes. This is the most common type of diabetes found in obese individuals. A total number of 18%–23% of subjects showed this type of diabetes.
- Cluster 5
This is another mild form of diabetes, which shows up in elderly individuals. It affects 39% to 47% percent of study subjects.
Another significant finding was that for each of these five types, there was genetic distinctness.
What is the significance of this study?
The assessment of the treatment given to the adults, belonging to each of the five clusters tells that they were not being treated properly. For example, it was found that 42% of the diabetic patients from cluster 1 and 29% of people from cluster 2 were given insulin therapy.
It shows that the current classification of diabetes doesn’t target the underlying features of the disease. It suggests that the old categorization of diabetes should not be in practice anymore.
Further study is required to define the exact mechanism and treatment options for these five new clusters of diabetes.