Friday, 22 June, 2018

Diabetes is really five different diseases, not just Types 1 & 2

There is often confusion between MODY and Type 1 Diabetes as both are found to affect young people or children. Type 1 Diabetes is diagnosed in those suffering from MODY leading to misdiagnosis Researchers propose 5 distinct types of adult-onset diabetes
Becky Salazar | 04 March, 2018, 05:08

These patients benefitted most from Metformin and had lower usage of insulin compared to cluster 1 despite being clinically similar to them in many ways.

"Diabetes is not the grey mass we have been calling type 2 - there are really subsets of the disease that require different treatment", said Groop. Clusters 3 and 4 can be thought of as falling between the two extremes.

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

And each comes with significantly different characteristics and risk of complications, they found.

"To support people to maintain a healthy weight and be more active, Bradford City and Bradford District Clinical Commissioning Groups (CCGs) are offering people at significant risk of diabetes across Bradford a place on the new NHS diabetes prevention programme". Most diagnoses are type 2 (75-85%), and while it's known that type 2 disease is highly variable, few attempts have been made to explore these distinctions.

More than 30 million Americans have diabetes, but a study published Thursday in the Lancet Diabetes & Endocrinology concludes we've been thinking about the disease all wrong.

With type-1 - generally diagnosed in childhood and accounting for about 10 percent of cases - the body simply doesn't make insulin, a hormone that helps regulate blood sugar levels.

On the other hand, the immune systems of individuals with Type 2 diabetes do not attack beta cells. I only have to look at my mum's workload to see that: as a diabetes specialist nurse, she's busier than ever, supporting patients throughout day to day management of their condition and some of the more serious complications of the disease, from blindness to kidney failure and limb amputation.

Severe autoimmune diabetes is largely the same as the classical type 1. Researchers replicated the findings in three further independent cohorts: the Scania Diabetes Registry (n = 1,466), All New Diabetics in Uppsala (n = 844) and Diabetes Registry Vaasa (n = 3,485). Identified in 15% of the people in ANDIS. The other mild form (cluster 4/ mild obesity-related diabetes (MOD)), was seen mainly in obese patients who fall ill at a young age and affected 18-23% of patients.

Cluster 5 (n = 3,513) was described as mild, age-related diabetes with older patients but only modest metabolic derangements, according to researchers. Diabetic eye disease was most common in this group.

How did the researchers interpret the results?

"The results of our study suggest that this new clustering of patients with adult-onset diabetes is superior to the classic diabetes classification because it identifies patients at high risk for diabetic complications at diagnosis and provides information about underlying disease mechanisms, thereby guiding choice of therapy", the researchers wrote.

This is a valuable study that suggests the diagnosis of diabetes may not be as simple as just types 1 and 2.

The findings might help to better tailor early treatment for patients, and might be a first step towards precision medicine, say the researchers.

Experts said the study was a herald of the future of diabetes care but changes to treatment would not be immediate. The clusters and associated complications will need to be verified in other populations, including other ethnicities that may have a different risk of diabetes, such as Asian populations.

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