Researchers identified genetically marked groupings of the disease that vary by severity, age at which they most often occur and probable complications.
A paper published in The Lancet Diabetes & Endocrinologyoutlines a more nuanced picture of the disease, however.
Cluster 1 - severe autoimmune diabetes, similar to the classical type 1, affected younger people who were otherwise healthy.
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This study analysed several cohorts and registries of people with diabetes from Sweden and Finland to look at the characteristics of people newly diagnosed with the disease. Now just over six people in every hundred have diabetes in the county - a shade under the national average of 6.6 but enough, says Diabetes UK, to cause concern. Subgroup classification was validated in three independent cohorts.
Group 3, the severe insulin-resistant diabetes is characterised by obesity and severe insulin resistance. The current system "has not been much updated during the past 20 years", the authors wrote in their paper, "and very few attempts have been made to explore heterogeneity of type 2 diabetes"-despite calls from expert groups over the years to do so".
"Implementing this clustering in the clinic could both guide the choice of therapy and help identify patients with a high risk of diabetic complications", lead author, Emma Ahlqvist, PhD, Lund University, told MD Magazine. "These included the age of diagnosis, body mass index, long-term glycaemic control, successful functioning of the insulin-producing cells in the pancreas, insulin resistance and presence of auto-antibodies associated with autoimmune diabetes". This group had the largest proportion of patients prescribed insulin (42%), as well as the shortest time to insulin use (HR 26.87 versus cluster 5, 95% CI 21.17-34.11).
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Previous clinical studies have noted that patients taking the drug tended to have lower blood glucose levels and that obese patients lost weight. In it, they created five categories of diabetes instead of two. For example, the researchers found that people who had cluster 3 or 4 diabetes had a higher risk of kidney disease or vision problems (retinopathy) than people in the other clusters. The most common cluster.
"This is the first step towards personalised treatment of diabetes", says Leif Groop, physician and professor of diabetes and endocrinology at Lund University in Sweden. He also added that future studies should investigate the effects of age on diabetes in patients.
However, this study alone is not sufficient to lead to changes in diabetes treatment guidelines, as it was only based on groups of diabetes patients in Scandinavia. He mentioned a caveat saying that this study cohort was a uniform Scandinavian population and thus all races and ethnicities were not adequately represented.
Future research is also needed to test and refine the 5 types to include biomarkers, genotypes, genetic risk scores, blood pressure and blood lipids.
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