Explained: 5 Types Of 'New' Diabetes- Diagnosis And Treatment

Diabetic diseases have long been classified as either type 1 or type 2, but the new research conducted in Scandinavia now indicates that such classification is over-simplistic. Published in The Lancet Diabetes & Endocrinology, this study reveals five distinct subtypes of diabetes and opens doors for more nuanced and personalized treatment strategies.

Simply, diabetes is when the glucose present in the blood is too high because of impaired functioning of insulin- a hormone in charge of regulation of glucose in the body. Type 1 diabetes occurs after the immune system attacks cells which produce insulin inside the pancreas, leading to a complete inability to produce this essential hormone. It most often presents with symptoms at young age and needs continuous insulin therapy.

Type 2 diabetes, on the other hand, is characterized by insulin resistance, where the body produces insulin but does not use it effectively. This type is generally linked to obesity, sedentary lifestyles, and genetics and often manifests in adulthood. While these classifications have guided treatment for decades, the new research divides diabetes into five distinct clusters, each with unique characteristics, risks, and management needs.

5 Cluster of Diabetes

1. Severe Autoimmune Diabetes (SAID)

This form of diabetes is very similar to the original concept of type 1 diabetes. This subtype is due to an autoimmune attack that destroys beta cells responsible for insulin production, leaving the body incapable of producing insulin. It usually occurs in younger people and necessitates tight blood sugar control and insulin therapy.

2. Severe Insulin-Deficient Diabetes (SIDD)

The other extreme type, but not autoimmune, is SIDD. This condition generally affects younger, nonobese people whose bodies do not produce enough insulin because the beta cells are damaged. Individuals diagnosed with SIDD are at the highest risk for complications, including blindness. Generally, treatment consists of insulin therapy, possibly combined with other orally taken medication.

3. Severe Insulin-Resistant Diabetes (SIRD)

SIRD is characterized by a significant resistance to insulin, often linked to obesity. People with SIRD struggle to use the insulin their body produces, resulting in poor blood sugar control. This subtype is associated with a higher risk of kidney disease, and current treatment options are less effective, emphasizing the need for new approaches to manage this group.

4. Mild Obesity-Related Diabetes (MOD)

This presents as a milder form of diabetes associated with obesity. Although these patients have some degree of insulin resistance, this is not as marked as it is in SIRD. Lifestyle interventions including weight loss and physical activity are particularly important in managing MOD, combined with conventional medications for diabetes.

5. Mild Age-Related Diabetes (MARD)

The most prevalent subtype, typically occurring in the elderly. It is less severe than other forms of diabetes, with fewer major complications. Lifestyle changes and oral medications, such as metformin, often are used to keep blood glucose levels within normal limits.

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What This Means for Diabetes Management

These five subtypes show that diabetes is complex, and one treatment fits all may not be applicable. In type 2 diabetes, metformin is currently the first drug prescribed to the majority of patients, and then other drugs are added if required. It might not be appropriate for all people, particularly for subgroups such as SIRD, who require more intensive therapies on insulin resistance.

Identifying these subtypes will also enable clinicians to direct appropriate treatments based on the specific risk profiles. For example, those classified as SIDD should have an earlier screen and preventive interventions to avoid blindness. In turn, SIRD may require specific interventions for renal protection.

This study represents a step forward, but it also opens up new questions. Researchers are exploring whether factors such as genetic markers or blood pressure measurements could further refine these subtypes. Furthermore, it is unclear whether a patient's classification might change over time, and so treatment plans need to be flexible and adaptive.

Therefore, findings in this field do not herald a need to completely change the type 1 and type 2 diabetes scheme currently in practice; they rather work as a guideline to develop individualized, high-precision and successful treatment systems in the years to come for the millions dealing with diabetes in today's times.

Diabetes is no longer just about type 1 or type 2. Five distinct subtypes have been identified, and the chronic condition's complexity has now opened the door to a new era of personalized care.

Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. The Lancet Diabetes & Endocrinologyl. 2018