suggest that diabetes mellitus should be reclassified based on multiple
- Scientists have
suggested the re-classification of diabetes based on several variables.
re-classification could be used to develop a more personalized approach to
the treatment of diabetes, which could in turn improve glycemic control
and reduce the chances of complications.
The new classification should replace
the conventional one that classifies it into two main types - type 1 and type 2
The study was published in the Lancet Diabetes &
strategies for diabetes are broad based - patients with type 1 diabetes are
usually treated with insulin, while the treatment of type 2 diabetes is usually
initiated with oral drugs, and insulin is administered when the patients no
longer respond to the oral drugs. This approach is not tailored to preventing
possible complications of diabetes. Thus, while some individuals respond well
to treatment, others progress to complications despite proper glucose control
with the treatment.
‘A reclassification of the types of diabetes could pave the way for the personalized treatments of diabetes patients.’
The scientists analyzed
information from three large diabetes registries and recorded the following
- The presence or
absence of glutamate decarboxylase antibodies; these antibodies are
present in patients with type 1 diabetes patients
- The age of the
individual at the time of diagnosis of diabetes
- The body mass index (BMI)
- The HbA1c
measurement. A level of less than 6.0% is considered normal
- The homoeostatic
model assessment 2 estimates of β-cell function. The β-cells are the cells
of the pancreas that secrete insulin
- The presence or
absence of insulin resistance based on the concentration of C-peptide
Based on the evaluation
of the data, the scientists found that they could group the individuals in five
clusters. These include three severe and two mild forms of the disease:
1 included patients with severe autoimmune diabetes (SAID)
individuals were insulin deficient, tested positive for GAD antibodies, had
poor metabolic control, and were young and lean with a relatively low BMI.
Cluster 1 corresponds to the current type 1 diabetes and latent autoimmune
diabetes in adults (LADA).
2 included individuals with severe insulin-deficient diabetes (SIDD)
antibodies were absent in these individuals. This group was at the highest risk
of diabetic retinopathy, a form of eye damage caused by diabetes that can
result in blindness.
1 and 2 had the highest HbA1c levels
, which indicated poor
diabetes control. Patients in these clusters were also more likely to suffer
from ketoacidosis at the time of diagnosis of the diabetes. Ketoacidosis is a
life-threatening complication of diabetes that results in high blood ketone levels.
It has to be treated on an emergency basis.
3 included individuals with severe insulin resistance (severe-insulin resistant
. They had a high body mass index, and were at the highest
risk for diabetic kidney disease.
4, referred to as mild obesity-related diabetes (MOD),
younger and obese individuals who were not insulin resistant.
5, referred to as mild age-related diabetes (MARD),
with diabetes that appeared at an older age and was associated with modest
There were several
limitations to the study, and the classification mentioned above cannot be
taken as a final say to modify the treatment of diabetes. Yet, the study has
some important take-home messages. All
patients with type 2 diabetes are not completely alike. By separating
individuals into clusters, they can be treated more specifically, not only to
control their diabetes, but also to prevent complications that they are most
likely to suffer from
The variety of
medications available for the treatment of diabetes has increased in the past
few years. An appropriate use of these medications in different populations of
diabetes patients could result in better outcomes and reduced complications.
1 and Type 2 Diabetes
condition where the blood levels of glucose rise and remain above the normal.
Persistent high blood glucose levels are associated with several complications.
Type 1 diabetes is a form of diabetes where the pancreas fail to produce
adequate insulin due to an immunological disorder; the patients develop
antibodies against the pancreatic cells that secrete insulin. The condition
often affects younger individuals, and is therefore referred to juvenile onset
diabetes. The affected individuals are usually lean and require life-long
treatment with insulin. Type 2 diabetes usually affects adults, who can be
treated with oral medications, until they progress to a point where they
require insulin. It occurs due to reduced sensitivity of tissues to insulin.
The affected individuals often tend to be overweight. Other lesser forms of
diabetes include latent autoimmune diabetes in adults (LADA), maturity-onset
diabetes in the young (MODY), and secondary diabetes.
- Emma Ahlqvist et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. The Lancet Diabetes & Endocrinology.
- Rob Sladek. The many faces of diabetes: addressing heterogeneity of a complex disease. The Lancet Diabetes & Endocrinology.