Thursday, July 2, 2020

Research Challenges Longstanding Classifications of Diabetes With the Discovery of Five Unique Types

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According to data from the World Health Organization, the number of people with diabetes has almost quadrupled since 1980. The condition is predicted to become the seventh leading cause of death worldwide by 2030. Up until recently, the understanding and approaches to management of the disease has rested upon its classification into two types.

Type 1 is an autoimmune condition where insulin is not produced by the body and typically begins in childhood. Type 2 is the more common form, occurring later in life, with strong links to weight and lifestyle factors like diet. In type 2, insulin production decreases or loses effectiveness leading to unstable glucose levels.

The latest data suggests it’s time for a radical overhaul of how diabetes is treated. Researchers in Sweden analyzed information gathered from 8,980 diabetics and discovered that there are not just two major categories of the disease, but five.

These findings have the potential to make an impact beyond the research community and shape how patients are treated. Leif Groop, the professor of diabetes and endocrinology at Lund University who led the team working on the project, highlights the potential: “For the patient, I think it will mean a more individualized therapy and a better quality of life.”

The five new subgroups are all genetically distinct with unique characteristics, including the age at which the disease develops and the risk of health complications. These differences will go a long way in explaining why some diabetics respond more favourably to treatment while others show limited improvement. By identifying the highest risk patients under the new classification, highly tailored approaches can be implemented to minimize the risk of complications, like kidney disease.

The Five New Classifications of Diabetes

  1. Type 1 diabetes and a late onset autoimmune form can be grouped together under a form the researchers call severe autoimmune diabetes. They agree that the current classification of this form is correct.
  2. Severe insulin-deficient diabetes is the first (and one of the worst) of the four variants currently under the type 2 classification. It has similar features to the autoimmune group, including low body mass index (BMI), lack of insulin and early onset. Diabetic eye disease is most common in this group. While metformin, an oral medication, is the first-line treatment for these patients, Groop says it may not be ideal: “They clearly need insulin very soon, almost as much as type 1.”
  3. Severe insulin-resistant diabetes is characterized by the cells’ lack of response to insulin, with patients showing a strong tendency to liver disease, chronic kidney disease and diabetic kidney disease. This group had a low proportion of metformin users even though researchers suggest they would benefit the most.
  4. Mild age-related diabetes is seen primarily in older patients and is easily managed by metformin and lifestyle modifications.
  5. The same treatment is recommended for mild obesity-related diabetes, which, as its name suggests, is linked to high BMI.

The months and years ahead will demonstrate how the medical and research community will build on these findings. One thing is certain: Those with diabetes can now hopefully look forward to better targeted treatment based on disease type.

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