Diabetes just got a little more complicated, or clearer, depending on your perspective.
Researchers in Scandinavia have proposed classifying diabetes as five types of disease, rather than two types, according to a new study. This research is corroborated by leading endocrinologists in Australia.
But what are these different types, and why did the researchers make this decision?
Having diabetes means that a person's blood sugar (glucose) levels are too high. It's an increasingly common disease; about 30 million people in the U.S. have diabetes, according to the Centers for Disease Control and Prevention.
Here in Australia we have 300 new cases of diabetes diagnosed every day. Of these about 7-8 percent are diagnosed as Type 1.
We have approximately 1.3 million diagnosed cases and an estimated 300,000 people more who have diabetes but have not yet been diagnosed. These statistics are rapidly changing for the worse as the diabetes continues to increase at a higher than ever rate.
In people with type 1 diabetes, which most often appears in childhood, the body cannot make insulin — a hormone that helps glucose get into cells. This condition occurs because the body's immune system attacks the cells in the pancreas that make insulin.
In type 2 diabetes, the body does not make or use insulin well. Often, this condition begins with insulin resistance, which means cells aren't responding to insulin, even though the body is still making the hormone. It is antiquated thinking to simplify things by thinking that as this condition often occurs in middle-age or older adults it is solely to be related to lifestyle factors and obesity. Many people who have this this disease did not all ask for it and for example there are non-obese fit and young indigenous children who at only seven years of age (previously a very prevalence low diabetes group) who now have Type 2 diabetes. We still have so much to learn!
In the new study, which was published in the journal The Lancet Diabetes & Endocrinology, researchers found that diabetes patients in Sweden and Finland fell into five clusters. One of the clusters was similar to type 1 diabetes, while the other four clusters were "subtypes" of type 2. Three of the clusters were considered severe forms of the disease, while two clusters were considered mild forms.
The 5 Clusters
- Cluster 1: Called "severe autoimmune diabetes", this form is similar to type 1 diabetes. People in this cluster were relatively young when they were diagnosed, and they were not overweight. They had an immune system (autoimmune) disease that prevented them from producing inulin.
Cluster 2: Called "severe insulin-deficient diabetes", this form was similar to cluster 1 — people were relatively young at diagnosis and were not overweight. They were also not producing much insulin. But, crucially, their immune system was not the cause of their disease. People in this cluster "looked for all the world like [they had] type 1" diabetes, but they didn't have "autoantibodies" that indicate type 1, Researchers aren't sure why this happens, but people in this group may have a deficiency in the cells that produce insulin.
- Cluster 3: Called "severe insulin-resistant diabetes", this form occurred in people who were overweight and had high insulin resistance, meaning their bodies were making insulin, but their cells were not responding to it.
- Cluster 4: Called "mild obesity-related diabetes", this form occurred in people who had a milder form of the disease, without as many metabolic problems as those in cluster 3, and they tended to be obese.
- Cluster 5: Called "mild age-related diabetes", this form was similar to cluster 4, but the people were older at their age of diagnosis. This was the most common form of diabetes, affecting about 40 percent of people in the study.
Clusters 2 and 3 are both severe forms of diabetes that were "masked within type 2 diabetes," the researchers said. People in these clusters may benefit from aggressive treatment to prevent diabetes complications, the authors said.
Improving diagnosesRecognizing subtypes of diabetes, as the new paper suggests, might change the way doctors prescribe medications for diabetes.
Right now, the algorithm for treating type 2 diabetes is pretty much a one-size-fits-all algorithm, but this will change.
Recognizing subtypes might help doctors more specifically choose a first, second or third medication for their patients.
Whatever your type of diabetes and your age, the Genteel painless lancing device encourages monitoring often and is one of the most useful and helpful devices ever invented.