December 13, 2018

Experts push to reclassify diabetes types

04 March 2018, 01:56 | Rodolfo Wallace

Emma Ahlqvist PhD

Emma Ahlqvist PhD Associate Professor Lund University

The researchers studied 14,775 patients across Sweden and Finland, analysing their genes and comparing disease progression, treatment and development of complications for each type.

Currently, the medical community broadly recognizes two types of diabetes, which is a disease that impairs the body's ability to properly produce or regulate blood sugar.

Cluster 1 describes diabetes similar to Type 1 diabetes wherein it is an autoimmune disease that affects young seemingly healthy people who can not produce insulin. Clusters 3 and 4 can be thought of as falling between the two extremes.

The study was just on Scandinavians and the risk of diabetes shifts extensively around the globe, for example, the expanded risk in South Asians.

Cluster 3: Severe insulin resistant diabetes, affecting 15.3 per cent of patients studied.

Other researchers caution that the team's results need to be replicated elsewhere, using even more diverse patient samples.

Where did the story come from?

The team, from Lund University and the Institute for Molecular Medicine in Helsinki, examined data from 14,625 patients in five cohorts between January 2008 and November 2016.

The researchers subsequently repeated the analysis in a further three studies from Sweden and Finland.

The results have been published in The Lancet: Diabetes and Endocrinology.

What kind of research was this?

Severe Autoimmune Diabetes largely overlapped with the current Type 1 diagnosis. The person is completely unable to produce insulin and relies on lifelong insulin.

And an estimated 550,000 people have Type 2 but are unaware of it. Management ranges from dietary control or medication through to daily insulin injections.

The scientists found one autoimmune type of diabetes - a condition in which the body produces chemicals that destroy insulin.

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What did the research involve?

Today, about 425 million people around the world have diabetes. It included 844 people.

Based on these parameters the participants were classified into 5 groups.

At present, around 400 million people globally are living with the disease, making it one of the biggest health issues facing modern medicine.

GADAs are antibodies linked with what is known as late-onset autoimmune diabetes (LADA).

The growing concern of type-2 diabetes needs no introduction - so, identifying a drug that is already in circulation that might help to fight the condition would be a welcome discovery.

Severe Insulin-Deficient Diabetes (SIDD) was made up of relatively young adults with especially poor metabolic control. About 6% of the people in the ANDIS study had SAID.

Initially looked very similar to cluster 1, but the immune system in these patients was not at fault. Identified in 18% of the people in ANDIS. Clusters 1 and 2 had a greater risk of diabetic ketoacidosis and had a higher HbA1c at diagnosis.

Most of the patients (nearly 40 percent) in the cohort belonged to the cluster 5. This cluster had the highest incidence of diabetic retinopathy.

Type 2 is also a lifelong condition, which generally develops later in life.

They believe the more precise groupings - each genetically distinct - will aid diagnosis, help tailor treatments and lead to precision medicines.

In the same way that a patient requiring a transfusion must receive the right blood type, diabetes sub-types need different treatments, the study suggested.

Researchers did not observe between-cluster differences for age- and sex-adjusted coronary event and stroke risk, and no genetic variant was associated with all the clusters.

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