Diabetes Diagnoses Just Got Clearer

You’re probably familiar with the two types of diabetes, even if you don’t know exactly what they are. Diabetes diagnoses are divided into two classes: Type 1, sometimes called juvenile onset diabetes, and Type 2. A new study published this month in The Lancet Diabetes & Endocrinology suggests there are actually several sub-types of diabetes, and figuring out which one you have will help you find the right treatment.

Current Types of Diabetes

Type 1 diabetes is an autoimmune disease that inhibits the pancreas’s insulin production. Insulin is a pancreatic hormone that regulates the blood’s glucose levels. When there is no insulin, blood glucose levels spike dangerously. Type 1 diabetes is a lifelong condition that generally appears during childhood or adolescence, although it does develop in adults as well.

Type 2 diabetes is also a chronic condition, but it usually appears later in life. It happens when the body’s cells don’t use insulin well, and the sugar builds up in the blood to dangerous levels.

There are many different risk factors—lifestyle, genetics, metabolic syndrome, to name a few—that contribute to diabetes developing. Although the end result is the same, type 2 diabetes caused by obesity is very different than type 2 diabetes caused by liver problems. Many times though, they’re treated exactly the same way.

A New Way to View Diabetes

With this new study, doctors may be able to add sub-classifications to their patients’ diabetes diagnoses, helping them provide specialized treatment for each patient. The researchers, studying diabetics in Sweden and Finland, found that there are five general “clusters” of the disease.

These alternate categories are not meant to do away with the traditional type 1 and 2 classifications. Rather, they will help doctors gain clarity and enhance treatment options.

The clusters are:

Cluster 1: Patients are diagnosed at relatively young ages, and are not overweight. The diabetes was caused by an immune system problem. This form corresponds to type 1 diabetes.

Cluster 2: This is called “severe insulin-deficient diabetes,” and looks similar to cluster 1 in that it develops in younger people who are not overweight. However, this form of diabetes is not caused by autoimmune disease, so it is in fact type 2 diabetes. In this case, patients may be misdiagnosed with type 1.

Cluster 3: This one is called “severe insulin-resistant diabetes.” It occurs in overweight people with high insulin resistance. Insulin resistance means the pancreas makes enough insulin, but the body’s cells don’t respond to it.

Cluster 4: Similar to cluster 3 but less severe, this form of the disease is called “mild obesity-related diabetes.” Patients in this cluster have a milder form of diabetes, with fewer metabolic issues. As the name indicates, they tend to be obese.

Cluster 5: “Mild age-related diabetes” is the last identified subtype, and is the most common form of diabetes. People develop this type of diabetes later in life, and it’s similar to cluster 4 in its lower level of severity.

How the Clusters Inform Treatment

The study found that patients in cluster 3 were at highest risk for developing kidney disease, while those in cluster 2 were most likely to develop retinopathy—a condition that can cause vision loss. Both are complications of diabetes, but knowing which diabetics are most likely to develop each can help doctors create specialized prevention plans.

This is a brand new study, so it will take some time until it makes its way into conventional care. But as they catch on, the clusters will end the one-size-fits-all paradigm in type 2 diabetes care. Knowing which subtype a patient has can enable the doctor to choose more specific medications and recommendations to target the specific form of the disease.

Future studies will tell us whether there are different causes for each subtype, and whether a patient’s classification can change over time. The clusters may also undergo further refinement, adding more subtypes.

In the meantime, if you or your loved one have diabetes, you may want to discuss this study with your doctor to see if it can help in your specific case.


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