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5 types of diabetes? What do we think?

HSSS

Expert
From another thread I was just reading it discusses

https://www.nhs.uk/news/diabetes/are-there-actually-5-types-diabetes/

They also looked at various patient characteristics, complication rates – such as kidney and diabetic eye problems – and use of medications. People were clustered according to 6 main characteristics:



      • age at diagnosis
      1. body mass index (BMI)
      • glycated haemoglobin (HbA1c) – a long-term indication of blood sugar control
      • function of the insulin-producing cells of the pancreas
      • level of insulin resistance – a measurement of how effectively, if at all, cells respond to insulin
      • presence of glutamate decarboxylase antibodies (GADA)
      GADAs are antibodies linked with what is known as late-onset autoimmune diabetes (LADA). LADA is often mistaken for type 2 diabetes because of its similar symptoms, but it needs to be treated in the same way as type 1 diabetes.
What were the basic results?
The researchers identified 5 main disease clusters.

  1. Severe autoimmune diabetes (SAID): this tended to start at a younger age, in people with a relatively low BMI, poor blood sugar control, insulin deficiency and GADA. About 6% of the people in the ANDIS study had SAID.

  2. Severe insulin-deficient diabetes (SIDD): GADA-negative but otherwise similar to SAID. Identified in 18% of the people in ANDIS.

  3. Severe insulin-resistant diabetes (SIRD): characterised by insulin resistance and high BMI. Identified in 15% of the people in ANDIS.

  4. Mild obesity-related diabetes (MOD): characterised by obesity but not insulin resistance. Identified in 22% of the people in ANDIS.
Mild age-related diabetes (MARD): people were generally older than those in other clusters and had only mild problems with glucose control, similar to MOD. Identified in 39% of the people in ANDIS.



So to me 1&2’s look like our type 1’s and LADA’S with and without antibodies.
3’s looks like classic type 2
4’s seem to be the people that respond well to any weight loss of any type eg low cal, low fat, low carb etc and don’t need to restrict carbs as much that I am convinced exist, also currently labelled type 2.
5’s older people, unclear what their IR status, obesity status or insulin producing status is

What happened to what’s currently called type 3 (illness/drug/surgery induced type 1??) and what about TOFI’s who would be a new 3 other than for the high bmi required

Edit. Maybe the current type 3 would fall in the new group 2

edit (the original link has been retired. Here’s a couple of others on the same topic https://www.medicalnewstoday.com/articles/321097 https://www.livescience.com/61917-diabetes-five-types.html). Doesn’t seem like anything came of it as the report is now a few years old but the topic is still interesting
 
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I think.....and the rest! There must surely be many, many varieties. I was 57 at diagnosis, BMI 22, hb1ac of 15%, C peptide lower end of normal, presence of GAD, insulin sensitive. What category am I???? They decided type 1.
 
Agree with your edit. Type 3 would be in the new group 2.
TooSweetForMe said:
Did you happen to see anything where gestational diabetics would fit into this new grouping of types?
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As GD is only a result of and for the duration of the pregnancy, then it isn't one the cluster types. It's a different diagnosis if the mother goes on to develop diabetes afterwards.
 
KK123 said:
I think.....and the rest! There must surely be many, many varieties. I was 57 at diagnosis, BMI 22, hb1ac of 15%, C peptide lower end of normal, presence of GAD, insulin sensitive. What category am I???? They decided type 1.
Click to expand...
Other than age you’d be closest to group 1 in my opinion. It says “tended to start at a younger age” not always, and covered LADA (type 1 slow/older onset) as the 1/2 group.

I’m not saying I agree with the groups in the study and it’s simplistic and unconfirmed still (it’s actually a couple of years old now) but there’s plenty of faults with the existing ones and at least for treatment purposes identifying those with different causes and responses would fine tune treatments, particularly when there’s options. I was just curious what people thought in general to more differentiated categories and what advantages and disadvantages such a system would have.
 

Hi Helen, I fully understand but I would want to know the type because if I was a type 2 (on insulin) for example, I would want to know whether I could come off the insulin/medication by trying a diet only approach. Or if I was a type 1 I might want to know that for sure because it might affect the chances of my children getting type 1 at a later stage, (my own Mum was type 1). I personally think the only way of managing diabetes to the best I can is by knowing what type I have got in the first place. x
 

To an extent I agree with you Helen, but whether we like it or not, the care of T1 and T2, by health professionals are quite different, with most usually T1s being cared for by specialist clinics with specialist HCPs and T2s; even most of those on insulin therapy are cared for, in primary care, with varying levels of expertise
 
KK123 said:
Hi Helen, I fully understand but I would want to know the type because if I was a type 2 (on insulin) for example, I would want to know whether I could come off the insulin/medication by trying a diet only approach
Click to expand...

As a LADA may be able to come of inslin for many years with lowcarb, I think the cpeptrade levels may be a better predictor then "type".
 


I see your point. But in order to access the right treatment, and understand the outlook for future, the right diagnosis is required first surely? The label is just a means to an end. In identifying new categories/labels you would hope they will be furthering knowledge of causes and potential treatments alongside and as a result of those investigations.

As you rightly say for those already on the correct treatment it will change nothing in practical terms. For others it’s could make a huge difference in treatment and understanding and potentially in prevention too.
 
ringi said:
As a LADA may be able to come of inslin for many years with lowcarb, I think the cpeptrade levels may be a better predictor then "type".
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It's highly unlikely a LADA would ever come off insulin as it the same end result as T1 i.e. low or zero insulin output due to beta cell death. Any LADA who 'recovers' from low-carb in the longer-term would probably be a mis-diagnosed T2?
 
Reactions: ert
HSSS said:
From another thread I was just reading it discusses




So to me 1&2’s look like our type 1’s and LADA’S with and without antibodies.
Click to expand...




Except LADA's don't have to have a relatively low BMI.
 
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ert said:
Except LADA's don't have to have a relatively low BMI.
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“Tended to” is not absolute. Also they are not specified in the report or my quotes as being in any of the listed groups other than to say they are treated like type 1’s.

LADA seems to come in all shapes and sizes.
 
HSSS said:
“Tended to” is not absolute. Also they are not specified in the report or my quotes as being in any of the listed groups other than to say they are treated like type 1’s.

LADA seems to come in all shapes and sizes.
Click to expand...

As to the Group 1 classification, the 'tended to' is in reference to age. It states that group 1's do have a relatively low BMI. But I agree with your statement that LADA comes in all shapes and sizes, which doesn't make them only fit only into group 1. They fit into other groups too, but with antibodies.
 
I read the list with the “tended to” applying to all of the conditions as if there were a semi colon after the words tended to

Regardless, the point of the thread was to discuss the value of further typing beyond the current 1,2,3 to assist in treatment decisions as a general topic- not to argue about the specific wording used in this specific report and how it might apply in individual cases. Maybe I wasn’t clear.
 
ert said:
Except LADA's don't have to have a relatively low BMI.
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I'd like to see some facts that support this. I suspect it may be true to some extent as it occurs later in life when BMI may have increased a bit but as LADA implies lack of insulin the body will often (most often?) present as slim due to fat burning.
 
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