Recent research from Sweden suggests that the two-pronged classification of diabetes-as type 1 or 2-may not be the best method for diagnosing and treating the disease.
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. Diabetes is growing faster than many other major health issues, yet the medical classification hasn't been updated in two decades. Rather than just type 1 and type 2 diabetes, there could be at least five broad ways the insulin disorder manifests.
In contrast, people can live with type 2 diabetes for years without realising it, but the condition can be reversed by adopting a more healthy lifestyle, and losing weight.
Dr Emily Burns of Diabetes UK said: 'Type one and type two diabetes are very different conditions but we don't yet know enough about the subtypes that could exist within them.
One, dubbed severe insulin-deficient diabetes, shows similar features to the autoimmune group such as relatively low body mass index (BMI), lack of insulin and early onset, but did not have telltale antibodies indicating an autoimmune disease.
"This is the first step towards personalised treatment of diabetes", said Leif Groop, Professor at Lund University in Sweden. It is an autoimmune disease, which means that the immune system mistakenly attacks the beta cells in the pancreas, which produce insulin. "In our cohort the insulin-resistant cluster patients received similar diabetes treatment as the age-related diabetes cluster patients in spite of significant differences in risk of complications, likely because current treatment goals are too focused on HbA1c levels, which are similar in the 2 clusters".
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.
The risk of diabetes varies significantly in people around the world, while this study only looked at Scandinavians.
Doctors now treat diabetics as either type 1 or type 2. These clusters can also understand the disease mechanism better they write adding that they used the key parameters that are used to monitor diabetes.
In addition to a more refined classification, the researchers also discovered that the different groups are more or less at risk of developing various secondary diseases.
Type 1 diabetes is a malady of the safe framework, which influences around 10% of individuals with the condition in the UK. A new classification system could help doctors identify the people most at risk for complications, the study authors say, and could pave the way for more personalized and effective treatments.
Diabetes influences around one of every 11 grown-ups worldwide and expands the risk of heart assault, stroke, blindness, kidney failure and appendage removal. This group had a low proportion of patients taking metformin, although the authors say they would be expected to benefit the most from the drug.
In the ANDIS study, blood samples were taken from people at registration, allowing the researchers to analyse their DNA and blood chemistry.
As for genetic links, there were no variants associated with all the clusters.
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