More Than Two Types of Diabetes?

For the past 20 years diabetes has always been classified as either type 1 or type 2, but new revelations show that there could actually be five different types.  New research such as one found in an article out of The Lancet: Diabetes & Endocrinology suggests a need for a revision to the diabetes classification system.  According to the article, despite experts expressing a need for it, not much emphasis has been given in the expansion of classifications for specific diabetic causes and severity levels.

Diabetes seems to be the fastest growing disease worldwide and known treatments don’t seem to be slowing it down or preventing long-term complications in many patients.  One possible reason is that diabetes is diagnosed based on one factor, how glucose is metabolized, but upon closer observation it is much more complex.  Today, diabetes is classified mainly by age of diagnosis, with younger patients usually having type 1, and on whether there are antibodies or not that attack beta cells which release insulin. Those with Type 1 cannot make their own insulin while those with type 2 can produce insulin but fail to utilize it properly.

New Subgroups for Diabetes.

It has been determined that between 75% and 85% of people with diabetes are classified as type 2, recently a third subgroup has been identified in recent studies known as latent autoimmune diabetes in adults (LADA).  Researchers from the University of Gothenberg and Lund University in Sweden are now claiming that additional subgroups are necessary.  To illustrate their claim they studied medical data from almost 15,000 Swedish people with type 2 diabetes and focused on not one but six factors that were documented at time of diagnosis.

• Age
• Body Mass Index
• Presence of beta-cell antibodies
• Metabolic control levels
• Beta-cell activity
• Insulin resistance

From this breakdown of data, five groups with considerably different characteristics emerge.

• Severe Insulin-Resistant Diabetes (SIRD) – Highest levels of insulin resistance  and highest risk of diabetic kidney disease.
• Severe Insulin-Deficient Diabetes (SIDD) – Mostly young adults with very poor metabolic control.
• Severe Autoimmune Diabetes (SAD) – Huge overlap with current type 1 diagnosis.
• Mild Age-Related Diabetes (MARD) & Mild Obesity-Related Diabetes (MOD) – Seemingly more benign forms of diabetes.

These new classifications could help distinguish high-risk patients and help doctors in prescribing more efficient treatments.  It can also be helpful to both newly diagnosed patients as well as those who have had type 2 diabetes for a long time.  Finally, it is not yet certain whether patients can move between these categories over time or if there are other factors that can further elaborate these sub-types of diabetes even further.  More in-depth studies are necessary, but it is clear that using several different factors to form a more specific diagnosis is a step in the right direction.

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