Scientists have come up with a new classification of diabetes

The study could not confirm if the five types have different causes nor if patients’ type changes over time

Recasting adult-onset diabetes into five types could help better tailor early treatment for patients, said the research by scientists from Lund University Diabetes Centre, Sweden, and Institute for Molecular Medicine Finland.

In their analysis of nearly 9000 patients with adult-onset diabetes, they identified five replicable clusters of disease, each with significantly different characteristics and risk of complications.

Cluster 5 (39.1 percent): Mild age-related diabetes, older than patients in other clusters and only modest metabolic derangements.

Type 1 diabetes - generally diagnosed in childhood - is caused by the body's immune system destroying the cells that release insulin, eventually ending insulin production from the body. Clinical characteristics included early-onset of the disease and being GADA positive, along with a lower BMI, poor metabolic control, and insulin deficiency. Similar to cluster 1 patients, this group includes young people of a healthy weight whose bodies do not produce insulin properly.

Cluster 2 was mainly defined as severely insulin-deficient as well as GADA negative. Diabetic eye disease was most common in this group.

The third cluster, accounting for 15.3% of the cohort, was marked by both a high degrees of insulin resistance - specifically a high HOMA2-IR index - paired with a high BMI. This group had a low proportion of patients taking metformin, although the authors say they would be expected to benefit the most from the drug.

Another mild diabetes form related to obesity (affecting between 18 and 23 percent of the cases).

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Still, the findings seem to be a positive step toward improved treatment of diabetes, which affects more than 420 million people worldwide. They explain that this method of classification could also be used in clinical trials for drugs used in diabetics for better results and deeper understanding of the mechanism of action of the drugs.

The other severe category, called severe insulin-resistant diabetes, is linked to obesity and shows a strong tendency for the body's cells not to respond to insulin, with these patients showing the highest likelihood of having liver disease, chronic kidney disease, and diabetic kidney disease.

Almost 15,000 patients in Sweden and Finland were monitored for a variety of factors, including age at diagnosis, body-mass index, long-term glycemic control, functioning of insulin production in the pancreas, insulin resistance, the detection of auto-antibodies, genetic analyses, disease progression, complications, and treatment success.

Researchers did not observe between-cluster differences for age- and sex-adjusted coronary event and stroke risk, and no genetic variant was associated with all the clusters. Instead, several genes were only associated with certain clusters.

Rob Sladek, MD, of McGill University, Montral, wrote an accompanying editorial with this landmark paper. The new study, she said, could help lead scientists towards a diabetes cure by changing the way they approach future study.

Diabetes: it's a life-long health condition, and it's on the rise. They're now working on a web-based tool that could assign patients to specific clusters. Further larger studies with diverse populations may be necessary before these results can be generalized. This project also received funding from the Innovative Medicines Initiative 2 Joint Undertaking and by the Swedish Foundation for Strategic Research.

The researchers identified 5 main disease clusters.

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