• Revision ID 54453 REVISION
  • 2018-03-09 23:19:49
  • by Roberta Bragg (talk | contribs)
  • Note: adding new type descriptions and treatment information
 
   
Title Title
Diabetes is five different diseases, says new research Diabetes is five different diseases, says new research
Summary Summary
Experts say the discovery marks a new step forward in diabetes treatment but that changing practices won't be immediate Experts say the discovery marks a new step forward in diabetes treatment but that changing practices won't be immediate
Highlights Highlights
Content Content
<strong><a href="http://www.bbc.co.uk/news/health-43246261">Diabetes consists of five separate diseases</a>, say scientists, and the <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlprts">discovery</a> could bring a new age of targeted and personalized treatment for a condition affecting <a href="http://www.who.int/mediacentre/factsheets/fs312/en/">nearly one in 11 adults</a> worldwide.</strong> <strong><a href="http://www.bbc.co.uk/news/health-43246261">Diabetes consists of five separate diseases</a>, say scientists, and the <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlprts">discovery</a> could bring a new age of targeted and personalized treatment for a condition affecting <a href="http://www.who.int/mediacentre/factsheets/fs312/en/">nearly one in 11 adults</a> worldwide.</strong>
[contribute-c2a text="You can edit and add more" buttons="edit"] [contribute-c2a text="You can edit and add more" buttons="edit"]
Finnish and Swedish researchers have discovered that sufferers of diabetes can be classified into five groups, depending on their diabetic symptoms and the complications that arise from them. <a href="https://en.wikipedia.org/wiki/Diabetes_mellitus">Diabetes</a> – a group of metabolic imbalances that can be characterized by high blood sugar levels over a prolonged period of time – is usually split into Types 1 and 2. Finnish and Swedish researchers have discovered that sufferers of diabetes can be classified into five groups, depending on their diabetic symptoms and the complications that arise from them. <a href="https://en.wikipedia.org/wiki/Diabetes_mellitus">Diabetes</a> – a group of metabolic imbalances that can be characterized by high blood sugar levels over a prolonged period of time – is usually split into Types 1 and 2.
The report suggests that whereas Type 1 diabetes is clearly associated with auto-immune deficiencies, Type 2 appears to be "highly heterogeneous," leading the researchers to identify four new subtypes, each with statistically clear distinguishing features in symptoms and complications, ranging from kidney to retinal problems. The report suggests that whereas Type 1 diabetes is clearly associated with auto-immune deficiencies, Type 2 appears to be "highly heterogeneous," leading the researchers to identify four new subtypes, each with statistically clear distinguishing features in symptoms and complications, ranging from kidney to retinal problems.
"This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes," said the report. "This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes," said the report.
Dr. Victoria Salem <a href="http://www.bbc.co.uk/news/health-43246261">told the BBC</a> that the study was a step forward for diabetes treatment but that it wouldn't lead to a change in practice just yet. Dr. Salem is a consultant and clinical scientist at Imperial College London. Dr. Victoria Salem <a href="http://www.bbc.co.uk/news/health-43246261">told the BBC</a> that the study was a step forward for diabetes treatment but that it wouldn't lead to a change in practice just yet. Dr. Salem is a consultant and clinical scientist at Imperial College London.
The study was based on data from 14,775 Scandinavians; the authors make clear in their paper that the applicability of these subtypes to other ethnic groups requires further investigation. The study was based on data from 14,775 Scandinavians; the authors make clear in their paper that the applicability of these subtypes to other ethnic groups requires further investigation.
Equally, whilst the researchers acknowledge that this may not yet be the optimum level of classification, it does already appear to be superior to the classic binary Type 1 vs. Type 2 distinction. A web-based tool for assigning patients to one of these subgroups is under development. The study was conducted by Lund University Diabetes Centre in Sweden and Finland's Institute for Molecular Medicine. The report has been published in <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr"><em>The Lancet Diabetes and Endocrinology</em></a> (<em>paid content</em>). Equally, whilst the researchers acknowledge that this may not yet be the optimum level of classification, it does already appear to be superior to the classic binary Type 1 vs. Type 2 distinction. A web-based tool for assigning patients to one of these subgroups is under development. The study was conducted by Lund University Diabetes Centre in Sweden and Finland's Institute for Molecular Medicine. The report has been published in <a href="http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr"><em>The Lancet Diabetes and Endocrinology</em></a> (<em>paid content</em>).
<span style="font-weight: 400">[contribute-c2a text="Discuss or suggest changes" buttons="talk"]</span> <span style="font-weight: 400">[contribute-c2a text="Discuss or suggest changes" buttons="talk"]</span>
&nbsp; &nbsp;
Current diabetes classification into type I (general early onset) and type II (late onset) diabetes has generally meant similar treatment and thus perhaps, in the case of Type II diabetes, not the most optimal outcome. Furthermore, a majority of diagnoses are based on a single test and on age of presentation. The prognosis of high risk complications has often been mistakelnly limited to type I diabetes while all type II diabetes patient are often seen to have a lesser risk and prognosis and thus are given a similar treatment modality. Current diabetes classification into type I (general early onset) and type II (late onset) diabetes has generally meant similar treatment and thus perhaps, in the case of Type II diabetes, not the most optimal outcome. Furthermore, a majority of diagnoses are based on a single test and on age of presentation. The prognosis of high risk complications has often been mistakelnly limited to type I diabetes while all type II diabetes patient are often seen to have a lesser risk and prognosis and thus are given a similar treatment modality.
The new study, which re-classifies diabetes into 5 types or clusters based on six charachteristics, shows distinct differences between the severity of complication risks which in turn may suggest , potential treatment adjustments and prognosis. It identifies 2 new types of diabetes (that previously would have been within the current type II classification) with high risk and severity that would indicate the need for earlier, more intesive treatment rather than waiting for complications to appear. It also seems to indicate that some patients may have had better results if treatment medications were differently prescribed. The new study, which re-classifies diabetes into 5 types or clusters based on six charachteristics, shows distinct differences between the severity of complication risks which in turn may suggest , potential treatment adjustments and prognosis. It identifies 2 new types of diabetes (that previously would have been within the current type II classification) with high risk and severity that would indicate the need for earlier, more intesive treatment rather than waiting for complications to appear. It also seems to indicate that some patients may have had better results if treatment medications were differently prescribed.
Decisions on cluster definition were made based on: Decisions on cluster definition were made based on:
. presence of antibodies that would indicate diabetes type I . presence of antibodies that would indicate diabetes type I
. age at diagnosis . age at diagnosis
. presence of obesity (Using BMI, a comparison of weight to height on a scale from normal to obese) . presence of obesity (Using BMI, a comparison of weight to height on a scale from normal to obese)
. tests (HbA) for insulin resistance, (a pathological condiation where insulin cannot be effectively used) . tests (HbA) for insulin resistance, (a pathological condiation where insulin cannot be effectively used)
. tests of beta cell function . tests of beta cell function
. identification of the presence of genes that indicate possibly diabetic association and or risks of complications.. . identification of the presence of genes that indicate possibly diabetic association and or risks of complications..
Cluster characteristics and current treatment Cluster characteristics and current treatment
1 earl- onset, relatively low BMI, 1 earl- onset, relatively low BMI,
poor metabolic control, poor metabolic control,
insulin deficiency, insulin deficiency,
high HbA* at diagnosis high HbA* at diagnosis
presense of GADA** presense of GADA**
most frequent ketoacidosis*** at diagnosis most frequent ketoacidosis*** at diagnosis
most present ZnT8A autoantibodies most present ZnT8A autoantibodies
shortest time to sustained insulin use shortest time to sustained insulin use
Severe autoimmune diabetes (SAID) Severe autoimmune diabetes (SAID)
current treatment current treatment
42% insulin at registraion, lowest no. of patients on metaformin 42% insulin at registraion, lowest no. of patients on metaformin
2 insulin deficient, low age onset, 2 insulin deficient, low age onset,
low BMI, insulin secretion low BMI, insulin secretion
poor metabolic control GADA negative high HbA* at diagnosis poor metabolic control GADA negative high HbA* at diagnosis
most frequent ketoacidosis at diagnosis most frequent ketoacidosis at diagnosis
next shortest time to sustained insulin use next shortest time to sustained insulin use
shortest tiome to second oral diabetes treatment shortest tiome to second oral diabetes treatment
longest time to reach treatment goal longest time to reach treatment goal
highest risk of retinopathy highest risk of retinopathy
severe insulin-deficinet diabetes (SIDD) severe insulin-deficinet diabetes (SIDD)
current treatment current treatment
29% insulin at 29% insulin at
registration, highest proportion on metaformin registration, highest proportion on metaformin
3 insulin resistance , 3 insulin resistance ,
high BMI high BMI
highest prevelance of non-alcoholic highest prevelance of non-alcoholic
fatty liver disease fatty liver disease
a genetic marker associated with type a genetic marker associated with type
2 diabetes not present 2 diabetes not present
higher risk of diabetic kidney disease than 4 or 5 higher risk of diabetic kidney disease than 4 or 5
severe insulin resistent diabetes (SIRD) severe insulin resistent diabetes (SIRD)
current treatment current treatment
&lt; 4% insulin at registration, low metaformin prescription*** &lt; 4% insulin at registration, low metaformin prescription***
4 obesity but not insulin resistance 4 obesity but not insulin resistance
mild obesity-related diabetes(MOD) mild obesity-related diabetes(MOD)
5 mild age related 5 mild age related
older older
modest metabolic derangement modest metabolic derangement
mild age-related diabetes (MARD) mild age-related diabetes (MARD)
&nbsp; &nbsp;
This initial classification and resulting risk assessment correlations in one group of newly diagnosed diabetes patients was replicated in 3 other groups of diabetes patients and not present in a control group of non-diabetic patients. Although most study participants were of Scandinavian ethnicity, and thus the results may not be true for all peoples, the study questions the rational for continuing to rely on the 2 classification system currently in use and suggest more studies. Meanwhile, individual evaluation of current diabetes patients might cautiously suggest changes in treatment especially if they appear to be in the new, higher risk clusters. The study authors indicate that a web based application to help new study developers and possibly clinicians separate patients into appropriate cluster definition is in development. This initial classification and resulting risk assessment correlations in one group of newly diagnosed diabetes patients was replicated in 3 other groups of diabetes patients and not present in a control group of non-diabetic patients. Although most study participants were of Scandinavian ethnicity, and thus the results may not be true for all peoples, the study questions the rational for continuing to rely on the 2 classification system currently in use and suggest more studies. Meanwhile, individual evaluation of current diabetes patients might cautiously suggest changes in treatment especially if they appear to be in the new, higher risk clusters. The study authors indicate that a web based application to help new study developers and possibly clinicians separate patients into appropriate cluster definition is in development.
* HbA strongest predictor of ketoacidosis disease In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased.excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion. excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion * HbA strongest predictor of ketoacidosis disease In ketoacidosis, the body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased.excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion. excessive thirst, frequent urination, nausea and vomiting, abdominal pain, shortness of breath, fruity-scented breath, confusion
**GABA Autoantibodies to Glutamate decarboxylase (GADA) have become the most commonly used predictive marker for type 1 diabetes **GABA Autoantibodies to Glutamate decarboxylase (GADA) have become the most commonly used predictive marker for type 1 diabetes
***ketoacidosis is a serious complication of diabetes and can result in death. ***ketoacidosis is a serious complication of diabetes and can result in death.
****the authors note that cluster 3 would be expected to benefit most from the use of metaformin ****the authors note that cluster 3 would be expected to benefit most from the use of metaformin
Categories Categories
Health Asia, Current Affairs, Finland, Health, Medicine, Pharmaceuticals, Science, Sweden, Technology, Health
Article type Article type
emerging emerging
Tags Tags
  Diabetes, Finland, Health, Institute for Molecular Medicine Finland, lancet, Lund University Diabetes Centre, medicine, new treatment for diabetes, Research, Science, Sweden
Author byline Author byline
Yes No
Has hero Has hero
Yes No
Hero Alignment Hero Alignment
full full
Hero Image URL Hero Image URL
None None
Featured Image URL Featured Image URL
  https://s3-eu-west-1.amazonaws.com/wikitribune-uploads-master/2018/03/diabetes.jpg
Sources Sources
<p><br data-mce-bogus="1"></p>  

Subscribe to our newsletter

Be the first to collaborate on our developing articles

WikiTribune Open menu Close Search Like Back Next Open menu Close menu Play video RSS Feed Share on Facebook Share on Twitter Share on Reddit Follow us on Instagram Follow us on Youtube Connect with us on Linkedin Connect with us on Discord Email us