5 different types of diabetes identified now

[Neoncat]

Why so cynical? Treatment doesn't always mean drugs. And even if it does who wouldn't want a treatment that is actually properly tailored to their condition? We already know what works for me won't work for someone else. Wouldn't you like your doctor to be able to give you better advice from the start rather leaving it up to you to figure out what works? Or if it is drugs a drug that will be tailored to your problem rather than working your way down a list? Also there is nothing wrong with drugs! I would have been dead a long time back without them

 

[Biggles2]

This large population based study used both registry information and genetic markers to identify and stratify diabetes into 5 distinct clusters. They also identified which complication was more prevalent in which cluster.

Cluster 1 was "Severe Autoimmune Diabetes" (SAID), characterised by early onset, relatively low BMI, poor metabolic control, indulin deficiency, positive GAD antibodies, and a markedly higher HbA1c on diagnosis: 30% of this group were in ketoacidosis on diagnosis. This group accounted for 6.4% of patients.

Cluster 2 was named "Severe Insulin Deficient Diabetes" (SIDD). This group accounted for 17.5% of patients in their study, and showed early signs of diabetic retinopathy than the other clusters. This group accounted for 17.5% of patients in their study.

Cluster 3 had a higher prevalence of NAFLD than the other clusters 15.3% of the patients in their study fell into this group.

Cluster 4 (21.6%) which they named "Mild Obese Diabetics (MOD)".

Cluster 5 (39.1) named "Mild Age-Related Diabetes" (MARD) was associated with older age and only modest metabolic derangement.

Complication screenings and other interventions can be more precisely targeted to patients that are at higher risk, which is the goal of precision-medicine.

I think that this study adds to the body of knowledge that we see anecdotally on this forum all the time. Diabetes is a heterogeneous disease - we are all different. As many have said above, the one constant for all of us classified as Type 2 is that our bodies produce too much insulin, and by we can manage this by balancing our carbohydrate intake to what our individual bodies can tolerate.

It also helps explain why the cured/remission/resolved discussion goes around in circles all the time!

 

[lucylocket61]

We can but hope although just look at all the opportunities for new drugs that 5 types will give them..
cynical moi?

regardless of their motives, the research and information will be useful.

 

[lucylocket61]

https://www.diabetes.co.uk/forum/threads/5-different-types-of-diabetes-identified-now.137455/

@DCUKMod can we merge the threads please?

 

[lucylocket61]

I think it is being proven is it not that T2 is largely but by no means completely attributed to poor lifestyle.

No. the diet of high carbs speeds up the response, which then lays down more and more fat in some people. One has to be susceptible to type 2, otherwise all those who eat high carbs or are obese would become T2.

A high carb diet is a contributory factor for some, but I wouldnt agree that it is a major cause of them then going on to become T2.

 

[lucylocket61]

also being discussed here; https://www.diabetes.co.uk/forum/threads/new-bbc-diabetes-article-very-interesting.137530/

 

[Fleegle]

This large population based study used both registry information and genetic markers to identify and stratify diabetes into 5 distinct clusters. They also identified which complication was more prevalent in which cluster.

Cluster 1 was "Severe Autoimmune Diabetes" (SAID), characterised by early onset, relatively low BMI, poor metabolic control, indulin deficiency, positive GAD antibodies, and a markedly higher HbA1c on diagnosis: 30% of this group were in ketoacidosis on diagnosis. This group accounted for 6.4% of patients.

Cluster 2 was named "Severe Insulin Deficient Diabetes" (SIDD). This group accounted for 17.5% of patients in their study, and showed early signs of diabetic retinopathy than the other clusters. This group accounted for 17.5% of patients in their study.

Cluster 3 had a higher prevalence of NAFLD than the other clusters 15.3% of the patients in their study fell into this group.

Cluster 4 (21.6%) which they named "Mild Obese Diabetics (MOD)".

Cluster 5 (39.1) named "Mild Age-Related Diabetes" (MARD) was associated with older age and only modest metabolic derangement.

Complication screenings and other interventions can be more precisely targeted to patients that are at higher risk, which is the goal of precision-medicine.

I think that this study adds to the body of knowledge that we see anecdotally on this forum all the time. Diabetes is a heterogeneous disease - we are all different. As many have said above, the one constant for all of us classified as Type 2 is that our bodies produce too much insulin, and by we can manage this by balancing our carbohydrate intake to what our individual bodies can tolerate.

It also helps explain why the cured/remission/resolved discussion goes around in circles all the time!

I was nodding and agreeing to all of this - I thought it was a great summary.

I also think it is good that people outside this forum realise it is not as simple as that - which is good.

I am not sure that everyone with T2 still produces too much insulin though? but almost certainly got to where they are by doing so. Some will have damaged or clogged their beta cells that it is hard to manage without additional insulin not less.

 

[JohnEGreen]

So this only applies to T1 or T2 all the other types of diabetes are completely ignored.

 

[bulkbiker]

So this only applies to T1 or T2 all the other types of diabetes are completely ignored.

I thought it more tried to reclassify all types of diabetes into these 5 groups? Although then again according to the Beeb there is a lot of concentration on age.. I can't get access to the original article without spending $31.50 access via The Lancet I'll see if I can find it anywhere else.

 

[bulkbiker]

So this only applies to T1 or T2 all the other types of diabetes are completely ignored.

This one seems to be the most complete.. Maybe someone who speaks "scientific study language" could take a look and translate for us mere mortals...

https://www.biorxiv.org/content/biorxiv/early/2017/09/08/186387.full.pdf

 

[paulus1]

so im obese metformin only i have non alcholic fatty liver so which group am i mod or the one before. im not sure even 5 will cover all the options.

 

[lucylocket61]

im not sure even 5 will cover all the options.

true, but its a strt in moving away form the rigid and narrow classifications they have now.

 

[Japes]

Me, I'm going with what the consultant said to me the other week. I'm "rare and unusual".

Certainly, I don't seem to fit anywhere in the five clusters for now.

But, on current treatment, my blood sugars are almost within range again, even if I've put some weight back on. (Mmmm... can't wait to get back to fewer carbs again.)

 

[Bluetit1802]

I don't know where I fit. It depends what they define "mild diabetes" as.
I think I may be MARD age related as I don't fully fit any of the others and my metabolic derangement was modest.

 

[Daibell]

Hmm. The five categories don't really cover many LADAs. There are many of us who became severely insulin deficient in middle age i.e. not 'Young' and not necessarily caused but the usual auto-immunity such as GAD. We are thin. Research has indicated that viruses have a part to play and much more research is needed. The focus on 'auto-immunity' causing insulin deficiency needs to resolved as it's too specific and none of the five new groups cover this.

 

[Mr_Pot]

If I had to self-diagnose, I suspect that I am MARD but previously not helped by being overweight. Basically with an impaired tolerance to carbs, there is a need to both reduce the load (lowish carbs) and also keep the fat off.

That's at least two of us then.

 

[JohnEGreen]

"
The team say the findings show that type 1 diabetes and a late-onset autoimmune form of diabetes can be grouped together as one form, dubbed severe autoimmune diabetes.

However the researchers say what would generally have been called “type 2” diabetes in fact encompasses four categories, two of which are severe forms of the disease."

So I am correct in assuming that this only applies to T1 and T2 diabetes.

 

[Boo1979]

Dont think I fit neatly into the categories - diagnosed at 39 with sugars at 28 but told Id been diabetic for at least 15-20 years. Significant (9-10 stone ) weight loss many years (17) prior to diagnosis. Still on same meds at same dose 21 years post diagnosis even tho they that are only meant to control T2 for 5-10 years max. Hba1c in non diabetic range

 

[Alexandra100]

can't wait to get back to fewer carbs again.

According to Jenny Ruhl, going low carb causes a big weight loss due to loss of fluid not fat, and adding carbs back into your diet entails a sudden weight gain which is additional fluid not fat. Hope that helps!

 

[Biggles2]

So I am correct in assuming that this only applies to T1 and T2 diabetes.

That was my take on it when I read the article. Cluster 1 included characteristics usually associated with Type 1 DM than Type 2. The remaining 4 clusters had characteristics usually associated with Type 2.