Scientists say diabetes is five separate diseases, and treatment could be tailored to each form.
Diabetes - or uncontrolled blood sugar levels - is normally split into type 1 and type 2.
But researchers in Sweden and Finland think the more complicated picture they have uncovered will usher in an era of personalised medicine for diabetes.
Experts said the study was a herald of the future of diabetes care but changes to treatment would not be immediate.
Diabetes affects about one in 11 adults worldwide and increases the risk of heart attack, stroke, blindness, kidney failure and limb amputation.
Type 1 diabetes is a disease of the immune system, which affects around 10% of people with the condition in the UK. It errantly attacks the body's insulin factories (beta-cells) so there is not enough of the hormone to control blood sugar levels.
Type 2 diabetes is largely seen as a disease of poor lifestyle as body fat can affect the way the insulin works.
The study, by Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland, looked at 14,775 patients including a detailed analysis of their blood.
The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.
- Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
- Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
- Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
- Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
- Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder
Sadly but not unexpectedly the researchers predict that drugs will be able to be targeted more effectively to suit the different needs of these various groups, but diet is never mentioned except by implication when they say that the 5th group (age-related mild diabetes) could be addressed by life-style measures. It seems to me that in fact diet is the one treatment appropriate to all groups.
Type 2 diabetes is largely seen as a disease of poor lifestyle as body fat can affect the way the insulin works. This from the BBC article. An interesting view on the causes of diabetes but that sentence stood out for me (the Guardian article doesn't say this) as it does nothing to refute the public's perception of T2. Or am I being over-sensitive. However, it's good news that there are studies to show that that view is simplistic at the very least. There's a long way to go, but there are signs of hope.
Yes, I totally agree. But since diet is the ONLY treatment that can benefit all types, it seems a shame it was not mentioned.But diet alone might not be enough
We can but hope although just look at all the opportunities for new drugs that 5 types will give them..It is good that they also recognise that if these 5 types are easily distinguishable in Scandinavian population, then other types may well exist elswhere.
Do you think that maybe, just maybe, people will begin to accept that different things work for different people with diabetes?
Let us hope, anyway.
We can but hope although just look at all the opportunities for new drugs that 5 types will give them..
cynical moi?
I ask the above as a question - I am genuinely interested if in fact T2 isn't related to poor lifestyle and weight. I think I am certainly guilty as charged personally.
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