Medicine

Lancet Research suggests five types of diabetes, treatment needs differ

March 02, 2018 18:24·
Researchers propose 5 distinct types of adult-onset diabetes

Researchers propose 5 distinct types of adult-onset diabetes

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.

Stemming from the All New Diabetics in Scania cohort, 8,980 Swedish patients newly diagnosed with diabetes were included in the hierarchical clustering. The province has extended the coverage to people belonging to the age group of 18 to 25 years.

The researchers measured insulin resistance, insulin secretion, blood sugar levels and age at onset of illness in determining the five classes.

The first cluster - defined as severe autoimmune diabetes - was the least common, with only 6.4% of the cohort fitting this type. Cluster 1 (n = 577) was characterized by early-onset disease, low BMI, poor metabolic control, insulin deficiency and presence of GADA.

Cluster 2 are severely insulin-deficient patients who were likewise young and healthy, and struggled with insulin, but the cause was not immune system failure. These patients had a higher risk of blindness.

The third cluster made up 15.3 percent of the whole cohort of participants. This group had relatively low use of metformin, despite the authors noting that this group would likely see the most benefit from such treatment.

Clusters 4 and 5 include mild diabetes.

They found cluster 3 was most resistant to insulin, and had significantly higher risk of diabetic kidney disease than those in clusters 4 and 5. "Evidence suggests that early treatment for diabetes is crucial to prevent life-shortening complications", he said in a statement. But cluster 3, which had the highest degrees of insulin resistance, showed a significantly higher risk for diabetic kidney disease than the other groups.

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While type 1 diabetes is generally diagnosed in childhood and caused by the body not producing enough insulin, type 2 occurs when the body can not produce enough insulin to meet increased demand imposed by obesity and insulin resistance (dearth of hormone receptors), and typically occurs later in life. Instead, several genes were only associated with certain clusters.

However, the study suggests that cluster 2 is probably due to a beta-cell defect, rather than being overweight, and that the treatment should therefore more closely mirror that for patients now classed as type 1.

"In interpreting these results, it is important to consider the effects of age on the prevalence of end-organ damage, particularly for patients with SIRD", Rob Sladek, MD, of McGill University in Montréal wrote in an accompanying editorial.

"We found that lefluonomide targets a protein involved in desensitising the insulin receptor, which is responsible for instructing the cells to start absorbing sugar from the bloodstream", said Xiulong Xu, Professor at the Institute of Comparative Medicine at Yangzhou University in China.

Rheumatoid arthritis, affecting approximately one per cent of the worldwide population, is a chronic auto-immune condition that causes pain and swelling in the joints.

The researchers noted that a web-based tool to assign patients to specific clusters, provided the appropriate variables have been measured, is under development.

The researchers later repeated the analysis in three studies from Sweden and Finland.

The researchers identified five clusters in both men (n = 5,334) and women (n = 3,646) in the ANDIS cohort.

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