Sunday, 18 November, 2018

Experts push to reclassify diabetes types

Researchers propose 5 distinct types of adult-onset diabetes A Study Proposes Five New Distinct Types of Adult-Onset Diabetes
Carol Daniels | 04 March, 2018, 02:00

"The most insulin resistant patients (Group 3) have the most to gain from the new diagnostics as they are the ones who are now most incorrectly treated", says Professor Leif Groop.

DIABETES is five different diseases, not two, experts have discovered.

For decades the disease has been considered to be two different forms - type one, an autoimmune disease in which people stop producing insulin, and type two, in which the body becomes resistant to insulin. It is usually diagnosed in childhood and is caused by the body's immune system wrongly destroying cells in the pancreas that make insulin.

The anti-inflammatory drug, lefluonamide, lowered blood glucose levels and reversed insulin resistance in mouse models of type-2 diabetes, which suggests that this therapy could be repurposed as an effective antidiabetic treatment, particularly suitable for patients with both diabetes and rheumatoid arthritis.

One autoimmune type of diabetes and four distinct subtypes of type 2 diabetes were identified by the researchers.

The first results of ANDIS - a study covering all newly diagnosed diabetics in southern Sweden-can be seen now.

The researchers said type one should be renamed "severe autoimmune diabetes".

It has always been known that type-2 diabetes is highly variable, but classification has remained unchanged for decades.

The study was carried out by researchers from Lund University, Uppsala University and the University of Gothenburg in Sweden; and Vaasa Health Centre and the University of Helsinki in Finland. For example, those in cluster 2 (insulin-deficient) had the highest risk of losing eyesight, while patients in cluster 3 (most resistant to insulin) showed a higher risk of developing diabetic kidney disease. It is the disease of individuals whose blood glucose or blood sugar levels are too high. New research confirms that in general it's most commonly diagnosed in the young.

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Cluster 5: Mild age-related diabetes is the biggest group, mostly elderly patients.

They believe the more precise groupings - each genetically distinct - will aid diagnosis, help tailor treatments and lead to precision medicines.

The most common form found was a moderate type found in mostly older people, while the other was a mild form found mostly in obese patients. The five types found had different characteristics, with different complications, and called for different treatment needs.

Other researchers caution that the team's results need to be replicated elsewhere, using even more diverse patient samples.

In the ANDIS study, blood samples were taken from people at registration, allowing the researchers to analyse their DNA and blood chemistry.

"Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment", explains Professor Leif Groop, who initiated the study.

There were 6 measurements analyzed that are used to monitor those with diabetes: age at onset of illness, body mass index, long-term glycemic control, insulin resistance, insulin secretion and presence of auto-antibodies associated with autoimmune diseases.

Cluster 4 are the patients with mild, obesity-related diabetes who are closer to those in cluster 3 in terms of insulin production.

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