Scandinavian researchers have found that uncontrolled sugar levels or diabetes, which is currently classified as only type 1 and 2, can be reclassified into five different categories.
According to the International Diabetes Federation, about 425 million people around the world have diabetes. This number is expected to rise to 629 million by 2045. Diabetes can lead to the development of kidney failure, retinopathy (eye damage), amputations and cardiovascular diseases.
This new substratification represents a first step towards precision medicine in diabetes and might eventually help to tailor and target early personalized treatment for patients.
The study, which was published in the international journal The Lancet Diabetes and Endocrinology, was conducted jointly by Lund University Diabetes Center in Sweden and the Institute for Molecular Medicine in Finland.
Researchers examined 13,720 newly diagnosed patients between the ages of 18 and 97 from the Swedish All New Diabetics in Scania cohort. By a detailed analysis of their blood, including measurements of insulin resistance, insulin secretion, blood sugar levels and age at onset of illness, the researchers were able to come up with these five separate classifications.
- Group 1: Severe autoimmune diabetes (SAID) essentially corresponds to type 1 diabetes and latent autoimmune diabetes in adults (LADA). It is characterized by the onset at a young age, poor metabolic control, impaired insulin production, and the presence of GADA antibodies.
- Group 2: Severe insulin-deficient diabetes (SIDD) includes individuals with high HbA1C, impaired insulin secretion, and moderate insulin resistance. Group 2 had the highest risk of vision impairment and blindness.
- Group 3: Severe insulin-resistant diabetes (SIRD) is characterised by obesity and severe insulin resistance. This group had the highest incidence of kidney damage – the secondary disease producing the highest costs to society.
- Group 4: Mild obesity-related diabetes (MOD) includes obese patients who fall ill at a relatively young age.
- Group 5: Mild age-related diabetes (MARD) is the largest group (about 40 percent) and consists of the most elderly patients.
Experts have said that the division of diabetes into type 1 and 2 only is not a particularly accurate classification system. According to the study, since some of the patients are at higher risk of developing secondary diseases, they could benefit from enhanced screening.
“This will enable earlier treatment to prevent complications in patients who are most at risk of being affected,” said Dr. Emma Ahlqvist, associate professor and lead author of the research, in a statement.
However, this study might not lead to changes being made in treatment immediately.
The study was conducted only on Scandinavian patients. The risk of diabetes varies considerably around the world and even more subgroups of diabetes may be discovered in the future.
“The longer the study is running, the more and better data we’ll get,” said Ahlqvist. “This will give us even better opportunities to tailor the treatment to each individual.”
Researchers are planning on conducting similar studies in China and India in the future.