A new research published online in March 2018 in the Lancet Diabetes Endocrinology gives five types of Diabetes. The study was led by Prof. Leif Groop, of the Lund University of Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland in Helsinki.
Diabetes is a group of metabolic disorders in which there are high blood sugar (hyperglycemia) levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger.
If left untreated, diabetes can cause many complications. Long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.
According to the International Diabetes Federation (IDF), an estimated 15.5 million adults aged 20 – 79 years were living with diabetes in the African region in 2017, representing a regional prevalence of 3.3%. The highest prevalence is found in adults aged 55 – 64 years and more than half (55.3%) of the adults living with diabetes residing in urban areas. It is said that about 62.9% of the population of adults are undiagnosed, currently living with diabetes and unaware of their condition.
Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are two main types of diabetes mellitus:
Type 1 diabetes is a disease of the immune system, by attacking the body’s beta-cells responsible for insulin production so there is not enough of the hormone to control blood sugar levels.
Type 2 diabetes is largely seen as a disease of poor lifestyle as body fat can affect the way the insulin works.
How Diabetes is Diagnosed
A diabetes diagnosis is normally made using the fasting plasma glucose (FPG) test or the A1C test. The FPG test assesses a person’s blood glucose level at a single time point, while the A1C test measures average blood glucose levels over the previous 3 months.
The Five ‘Clusters’ of Diabetes
The researchers came to their proposal by analyzing the data of four study cohorts, which included over 14,775 adults from Sweden and Finland, all of whom had been newly diagnosed with diabetes.
Before arriving at a conclusion, the researchers adopted six measures :
- body mass index (BMI);
- age at diabetes diagnosis;
- hemoglobin A1C (HbA1C), a measure of long-term blood sugar control;
- beta cell functioning;
- insulin resistance; and
- the presence of diabetes-related autoantibodies.
The study revealed five different forms of diabetes, which are:
- Cluster 1 (type 1 diabetes): Encompasses people who are unable to make insulin because of a severe autoimmune disease. These are individuals first diagnosed when they were young.
- Cluster 2 (type 2 diabetes): A similar group to cluster 1 in terms of severe insulin-deficient diabetes, except that the immune system didn’t cause their problem. These patients had poor metabolic control, as shown by a high A1C, a two- to three-month average of blood sugar levels. Early signs of vision loss due to diabetic retinopathy were more common in this cluster than any other.
- Cluster 3 (type 2 diabetes): This group was overweight and making insulin, but their body was not responding to it. They were considered severely insulin resistant. This group had a significantly higher risk of diabetic nephropathy.
- Cluster 4 (type 2 diabetes): People in this group had mild obesity-related diabetes, but metabolically, they were healthier than group 3.
- Cluster 5 (type 2 diabetes): People in this group were much older when they were first diagnosed, and their disease was the mildest and progressed slowly.
The team points out that just 42 percent of patients in cluster 1 and 29 percent of patients in cluster 2 received insulin therapy from the point of disease onset.
While further research is required to refine these five clusters, by using biomarkers and genetic risk scores, for example, the team believes that this study is a great stride toward tailored treatments for diabetes.
“Existing treatment guidelines,” concludes Prof. Groop, “are limited by the fact they respond to poor metabolic control when it has developed, but do not have the means to predict which patients will need intensified treatment.
“This study moves us towards a more clinically useful diagnosis and represents an important step towards precision medicine in diabetes.” said Prof. Leif Groop.
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