Diabetes in adulthood - five instead of two different forms

Are there more forms of diabetes than Type 1 and Type 2?

More and more people in Germany suffer from diabetes. The disease has always differentiated between type 1 diabetes and type 2 diabetes. Researchers have now discovered that adult diabetes can be divided into five distinct categories.

The researchers at Lund University found in their study that diabetes in adulthood must be divided into five different categories. The researchers published the results of their study in the English-language journal "The Lancet Diabetes and Endocrinology".

Does diabetes have to be subdivided into five main forms in the future instead of just two? (Image: Andrey Popov / fotolia.com)

All subgroups are genetically different

The experts explained that all newly classified subgroups are genetically diverse and show many differences, including the age at which they occur and the different risks for complications such as kidney disease. The results provide information about why some diabetics react very differently to the treatment. The new findings could identify diabetics who are at high risk for complications. This would contribute to a tailor-made treatment of the disease. Such an individualized therapy could lead to an improved quality of life for patients, explains study author Professor Leif Groop from Lund University.

So far, diabetes divided into only two main forms

Currently, diabetes is divided into two main forms, both of which have links to genetics. Type 1 diabetes is an autoimmune disease in which the hormone insulin is not produced. This form of diabetes usually develops in childhood. The more common type, type 2 diabetes, results in the production of very little insulin or no glucose uptake by the body cells. This form of the disease generally develops later in life and is often associated with obesity. The latest study suggests that this classification of diabetes is too easy.

Physicians examined 8,980 diabetics

In their research, the researchers have now identified five subgroups by analyzing data from a total of 8,980 diabetics from Sweden. The results were confirmed by data from 5,795 other adult patients in three other databases from Sweden and Finland.

Type 2 diabetes actually includes four categories of the disease

The team says the results show that type 1 diabetes and a late autoimmune form of diabetes can be grouped together into a form called severe autoimmune diabetes. The researchers say, however, that what is commonly referred to as type 2 diabetes actually includes four categories of the disease, two of which are particularly severe forms of the disease.

What is severe insulin-deficient diabetes?

A form known as severe insulin-deficient diabetes shows similar features to the autoimmune group - such as a relatively low body mass index (BMI), insulin deficiency, and early onset in life - but has no tell-tale antibodies to indicate an autoimmune disease. The so-called diabetic retinopathy occurs most often in this group, say the doctors. Also, this group has the highest proportion of patients who used the drug metformin, which is not the optimal treatment for this disease, the researchers explain. Those affected will soon need insulin, almost as much as patients with type 1 diabetes, adds Professor Groop.

In the case of diabetes, blood pressure, blood sugar and lipid levels must be checked regularly by a doctor. (Image: Andrey Popov / fotolia.com)

What is severe insulin-resistant diabetes?

The other severe category, termed severe insulin-resistant diabetes, is associated with obesity and shows a strong tendency for the body cells to not respond to insulin, which patients are most likely to have liver disease, chronic kidney disease, and diabetic damage To develop kidney. This group had a low proportion of patients taking metformin, although the authors say they would benefit most from the drug.

Which forms are still there?

The other two categories are mild forms of the disease. One of these is called mild obesity diabetes, this form is associated with a high BMI. The other form is the so-called mild age-related diabetes, which generally occurs in older patients. The physicians explain that both categories can be treated with metformin and a lifestyle consultation.

How were the categories determined in the study?

The categories were determined by considering six different measures, including a measure of glycemic control, age at diagnosis, BMI, the presence of certain antibodies associated with autoimmune diabetes and a measure of insulin sensitivity.

Further research is needed

The results of the study are a promising step to differentiate type 2 diabetes in more detail, but further research on the subtypes must be carried out before understanding what the disease subtypes mean to people suffering from diabetes are, say the experts. (As)