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Diabetes has five subgroups not just type 1 or type 2, new research suggests

Adult diabetes may fall into five different categories rather than type 1 and type 2 diabetes, according to new research. A study conducted by researchers at Lund University in Sweden found new classifications for diabetes, each with their own distinct genetics and characteristics.

It is hoped the stratification of the condition into more subgroups will help with physicians develop more individualized treatment regimens and identify patients with an increased risk of complications at an earlier stage. The authors of the report suggested the findings represent the “first step towards precision medicine in diabetes”. 

Leif Groop, professor of diabetes and endocrinology at Lund University and leader of the study, explained: “Diabetes is not the grey mass we have been calling type 2 - there are really subsets of the disease that require different treatment.” Researchers suggested what is currently known as type 2 diabetes should be divided into four subcategories. The study analyzed data from 8,980 diabetes in Sweden and confirmed this using data from 5,795 other adult patients.

The research published in the journal The Lancet Diabetes and Endocrinology identified a total of five subgroups for diabetes, each with different characteristics, disease progression, and complication risks. These were discovered by examining six factors, including: insulin sensitivity, body mass index (BMI), age at which the condition was diagnosed, blood glucose control and the presence of certain antibodies linked to autoimmune diabetes. 

Characteristics of the new classifications:

   1.   An autoimmune condition in which the hormone insulin is not produced - the same as type 1 diabetes.
   2.   Similar to “cluster 1” - it often affects young people and those who are not overweight but struggle to create insulin.
   3.   Generally occurs in those who are overweight - the body produces insulin yet does not respond to it.
   4.   Mild diabetes - related to obesity.
   5.   Mild diabetes - related to age and often with milder symptoms.

Two of the new categorizations were identified as severe subgroups. Patients in the second “cluster”, dubbed severe insulin-deficient diabetes, had the highest risk of diabetic retinopathy and were far more likely to be taking the drug metformin, although study authors suggested this was not the ideal treatment. “They clearly need insulin very soon, almost as much as type 1,” Groop asserted. 

The other severe category was the third cluster, named severe-insulin resistant diabetes. Patients with this form of diabetes had the highest resistance to insulin and a significantly higher risk of developing diabetic kidney disease. Researchers suggested these patients could be among those who benefit most from metformin, yet the study found a relatively low proportion were taking the drug.

Researchers also noted that subgroups are genetically distinct and the groupings identified were the same for patients with newly diagnosed conditions and long-term patients, indicating that the five categories are not simply manifestations of different stages of the same form of the disease.

Facts about Diabetes in the United States

  • Diabetes affects around 30 million patients (nearly one in ten people) in the United States, according to the National Diabetes Statistics Report 2017.
  • Type 2 diabetes is significantly more common, accounting for around 90 percent of cases in the United 
  • One in three adults have prediabetes (the precursor stage to diabetes mellitus in which blood sugar is abnormally high but insufficient symptoms are present to fully diagnose the condition).
  • 224 million prescriptions for diabetes drugs and products were filled, making it the seventh most commonly prescribed drug class, according to figures from the IQVIA Institute for Human Data Science.