Swedish researchers suggest 5 types of diabetes, not 2

Former Reporter
03/27/2018 08:00 AM
Main Cherokee Phoenix
Heidi Lyman, left, of Kansas, Oklahoma, receives instruction from Brenda Fowler, a registered nurse for W.W. Hastings Hospital’s Diabetes Management, on how to use a glucometer to test her blood sugar level in this 2013 photo. A new research article claims there are five types of diabetes classifications, challenging the long-held idea that there are only two. ARCHIVE
TAHLEQUAH – A new research article in the health journal “The Lancet: Diabetes & Endocrinology” claims there are five types of diabetes classifications, challenging the long-held idea of only two.

Researchers from Sweden’s University of Gothenburg and Lund University write that the new classifications pave the way “towards precision medicine in diabetes” and “individualize treatment regimens and identify individuals with increased risk of complications at diagnosis.”

Diabetes is classified into Type 1 and Type 2 and is the fastest-growing disease worldwide, making it a substantial threat to human health, according to an international network of health scientists.

Traditionally diabetes has been diagnosed only by measuring glucose, but the new study examined six variables in nearly 15,000 patients to determine cluster categories of diabetes including body mass index, age at diagnosis and glutamate antibodies.

Individuals with Severe Autoimmune Diabetes (SAID) were characterized with poor metabolic control and the presence of glutamic acid decarboxylase antibodies (GADA). Cluster 2 individuals with Severe Insulin-Deficient Diabetes (SIDD) were similar to cluster 1, but GADA negative.

Insulin resistance and high BMIs characterized individuals with Severe Insulin-Resistant Diabetes (SIRD) in cluster 3, while cluster 4 patients with Mild Obesity-Related Diabetes (MOD) also had a high BMI but were not affected by insulin resistance. Cluster 5 patients with Mild Age-Related Diabetes (MARD) were similar to cluster 4, but characterized as older patients.

Dr. James Stallcup, Cherokee Nation’s Health Services chief medical director, said Health Services has its doctors “constantly” review new studies to assure patients they are receiving “state-of-the-art treatment.” The new study “doesn’t surprise” him, he said.

“With the sophistication of both the lab testing and computers that we use in health care, it doesn’t surprise me at all that we are finding clusters of patients who share clinical findings outside of traditional Type 1 or Type 2 diabetes,” he said. “Diabetes care is advancing at a very rapid pace, and many things that doctors had previously dreamed of, things like continuous blood sugar monitors and long acting insulin, are now becoming common.”

Stallcup said he’s seen firsthand how the categories do not fit all patients.

“(Type 1 and Type 2) works for many patients, but most practicing doctors have found patients that don’t really fit into one of these categories. When I was in training, a third type of diabetes became apparent, adult patients that developed diabetes as if they were kids. This is now called Latent Autoimmune Diabetes of Adulthood or LADA,” he said.

While the new study does not make LADA its own classification, it did note that it initially begins indistinguishable from Type 2, but becomes “increasingly similar to Type 1 diabetes over time.”

Researchers believe the new classifications could aid in tailoring and targeting treatment plans for patients based on specific needs, including for individuals with SIRD that had a “significantly higher” risk of diabetic kidney disease when compared to MOD and MARD individuals, yet were prescribed “similar diabetes treatment.”

“The distinctions between types of diabetes affects the way patients get treated,” Stallcup said. “I’m not sure how many ultimate categories of diabetes will be defined, but hopefully this will help us better predict the services that these patients need, and what interventions may help them. We take great interest in preventing diabetes as well. We are happy to serve anyone suffering from or at risk of developing diabetes.”

The report calls for further studies to determine whether patients can move between the five proposed classifications and concluded that while researchers cannot definitively say the new system would be the “optimal classification of diabetes subTypes,” it does “provide a first step towards a more precise, clinically useful stratification.”


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