Five types of diabetes

Diabetes mellitus was called "five different diseases"

Anna Kerman, XX2 century

The authors of the new study claim that diabetes mellitus, in fact, is five different diseases, and treatment needs to be modified taking into account the form of the disease in a particular patient.

Diabetes mellitus, or a violation of blood glucose control, is usually divided into two types, the first and the second. But an international team of researchers from Sweden and Finland believes that in reality the picture may be more complex. Their discovery could be the beginning of an era of individualized diabetes treatment. However, according to experts, an immediate change in existing protocols for the treatment of diabetes should not be expected.

Diabetes affects every 11 adult inhabitants of the planet. This disease is associated with an increased risk of heart attacks, strokes, blindness, kidney disorders and limb amputation.

Traditionally, there are two types of diabetes.

• Type 1 diabetes mellitus is an autoimmune disease. The immune system attacks the so-called islet cells. Since these cells in the body are engaged in the synthesis of insulin, after their death, the level of this hormone decreases, which leads to an increase in blood glucose levels.

• Type 2 diabetes is usually called a disease of an incorrect lifestyle, because during the development of this disease, excess fat in the body disrupts the normal functioning of insulin.

As part of a new study conducted on the basis of the diabetes center of Lund University (Sweden), scientists studied blood tests of 14,775 patients diagnosed with diabetes mellitus. It turned out that patients can be divided into 5 groups:

• Cluster 1. Severe autoimmune diabetes, developing in much the same way as classic type 1 diabetes mellitus. The disease, as a rule, begins at a young age in practically healthy people. At the heart of the disease is a violation of insulin production.

• Cluster 2. Severe insulin-deficient diabetes. At first glance, the patients of this subgroup differ little from the patients from the previous one – they are young healthy people with normal weight, but impaired insulin synthesis. However, the immune system has nothing to do with this case.

• Cluster 3. Severe insulin-resistant diabetes. Patients tend to be overweight. The body of patients continues to produce insulin, but the cells stop responding to it properly.

• Cluster 4. Moderate diabetes associated with obesity. The weight of patients from this group, as a rule, is much higher than similar indicators in cluster 3, but the metabolism is much closer to normal.

• Cluster 5. Moderate age-related diabetes. This disease develops much later than other forms of diabetes, and the disease itself is easier.

Today's classification (left, blue sector – rare forms of diabetes) and the new one (right). Figure from the Lund University press release Paradigm shift in the diagnosis of diabetes – VM.

Professor Leif Groop, one of the authors of the work, told the BBC: "This is extremely important, we have taken a step towards personalized medicine. Patients suffering from one of the three severe forms of the disease should receive more aggressive therapy than those with a relatively mild form of the disease."

Currently, patients assigned by researchers to the second cluster are diagnosed with type 2 diabetes mellitus, since they do not have an autoimmune disease. But the authors of the work suggest that their disease may be caused by a defect in the islet cells themselves, and not by obesity at all. And therapy in this case should be close to those schemes that are prescribed to patients with type 1 diabetes.

Interestingly, the possible complications of diabetes also vary from cluster to cluster. Patients from the second cluster are more likely to go blind, while patients from the third are more likely to develop kidney disease. Given this fact, doctors could prescribe appropriate screening examinations in a timely manner.

A better classification of diabetes

Dr. Victoria Salem, a consultant physician and scientist from Imperial College London, claims that most specialists already know that the division of diabetes mellitus into types 1 and 2 "cannot be called a very accurate classification."

Dr. Salem also added that the results of the new study "are the future of our understanding of diabetes as a disease." However, she noted that immediate changes in the current clinical practice should not be expected. The study used data exclusively from Scandinavian patients, while the risk of developing diabetes in representatives of different nationalities is not the same. For example, it is higher for people from South Asia.

Dr. Salem explained, "A huge number [of diabetes varieties] may still be unknown. Perhaps there are 500 subtypes of the disease in the world, which differ depending on hereditary factors and the characteristics of the environment in which people live. The analysis included 5 clusters, but this number may grow."

In addition, it is still unclear whether the results of treatment will improve if therapy is prescribed in accordance with the classification proposed by the authors of the new work.

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