Diabetes, Heart and Cardiovascular Diseases News Chronicle.  Diabetes, Cardiovascular and Heart Diseases
 Article 325
    Published on April 19, 2018


Re-categorization of diabetes into five clusters for a precise diabetes diagnosis and an individualized treatment

With the current diabetes classification and guidelines, a healthcare professional can not forecast precisely which patient requires to be intensified diabetes treatment and how to control a newly diagnosed diabetes patient with high blood sugar or glucose levels. Currently, diabetes is categorized as


  • Type 1 diabetes : This is an autoimmune disease. This type of diabetes is caused due to the destruction of insulin producing beta-cells by the immunity of the patient.
  • Type 2 diabetes : This type of diabetes is caused due to the increase in glucose or sugar levels in the bloodstream as the cells can not absorb the glucose present in the blood due to insulin resistance developed in the body.
  • Latent autoimmune diabetes in adults (LADA) (or unofficially called as type 1.5 diabetes).
  • Maturity-onset diabetes in the young (MODY) : This type of diabetes is caused due to defects in the insulin secretion in the pancreas. This occurs in people aged less than 25 years.
  • Secondary diabetes : This diabetes is caused due to the destruction of beta cells in the pancreas and/or acquired diseases (such as endocrinopathies) causes the development of insulin resistance.

In a study intended to find out precise diabetes diagnosis and individualized diabetes treatment, researchers from Sweden and Finland led by the experts from the Lund University, Lund, Scania, Sweden have suggested re-categorization of diabetes.


Researchers have conducted studies on 13,270 newly diagnosed diabetes patients aged between 18 to 97 years. They say diabetes can be reclassified based on physiological and genetic profiles into three severe diabetes clusters and two mild diabetes clusters. They also studied diabetes development and available treatment options to the newly diagnosed patients. One of the newly reclassified clusters is similar to type 1 diabetes and the other four clusters are subtypes of type 2 diabetes. Researchers isolated following parameters during the reclassification studies.

  • Insulin resistance : A condition in which insulin calls (call to the transfer of energy and oxygen from the bloodstream to cells) are rejected by the body cells.
  • Insulin secretion : Amount of insulin produced by the beta cells in the pancreas.
  • Blood sugar levels : Amount of sugar or glucose produced by the liver from the food we eat.
  • The onset of diabetes.
  • Age.

Researchers have observed following during their study.

Cluster name Researchers observation
Cluster 1
Severe autoimmune diabetes (SAID)
  • Patients are found to be with the highest levels of HbA1c (or blood sugar or glucose levels) in the bloodstream.
  • About 31 percent likely presence of ketoacidosis at diagnosis compared to patients in cluster 3, 4 and 5.
  • About 42 percent of the patients are using insulin.
  • The lowest number of patients are using metformin.
Cluster 2
Severe insulin-deficient diabetes (SIDD)
  • Patients are found to be with the highest levels of HbA1c (or blood sugar or glucose levels) in the bloodstream.
  • About 25 percent likely presence of ketoacidosis at diagnosis compared to patients in cluster 3, 4 and 5.
  • About 29 percent of the patients are using insulin.
  • A maximum number of patients are using metformin.
  • Patients in this cluster are at highest risk to the development of diabetic retinopathy.
Cluster 3
Severe-insulin resistant diabetes (SIRD)
  • Usage of insulin is less than 4 percent.
  • The lowest number of patients are using metformin.
  • Patients in this cluster are at highest risk to the development of diabetic nephropathy and chronic diseases.
  • Patients are with a modest increase in urine albumin (a risk to kidney disease). People in this cluster are at higher risk of end-stage renal disease.
Cluster 4
Mild obesity-related diabetes (MOD)
  • Usage of insulin is less than 4 percent.
Cluster 5
Mild age-related diabetes (MARD)
  • Usage of insulin is less than 4 percent.


In the new diabetes classification, researchers have proposed following diabetes clusters for a precise diabetes diagnosis and an individualized treatment.

Cluster name Characteristics of the diabetes patient in the cluster
Cluster 1
Severe autoimmune diabetes (SAID)
  • An autoimmune condition, where beta cells in the pancreas could not able to produce sufficient insulin to maintain sugar or glucose levels in the bloodstream.
  • Presence of glutamic acid decarboxylase (GAD) antibodies in the bloodstream.
  • Diabetes condition with the highest levels of HbA1c (or blood sugar or glucose levels) in the bloodstream.
  • Correspond to type 1 diabetes and latent autoimmune diabetes of adults LADA (or unofficially called as type 1.5 diabetes).
  • Affected people are relatively low in body mass index (BMI) with poor metabolic control.
  • Affect people at a young age.
Cluster 2
Severe insulin-deficient diabetes (SIDD)
  • Patients in this cluster are similar to Cluster 1 (severe autoimmune diabetes SAID), but without glutamic acid decarboxylase (GAD) antibodies in the bloodstream.
  • Diabetes condition arises as beta cells in the pancreas fails to produce sufficient insulin.
  • Diabetes condition with the highest levels of HbA1c (or blood sugar or glucose levels) in the bloodstream.
  • The highest incidence of retinopathy.
Cluster 3
Severe-insulin resistant diabetes (SIRD)
  • Patients in this cluster are with higher body mass index (BMI).
  • Beta cells in the pancreas produce sufficient insulin required to transfer sugar or glucose along with oxygen from the bloodstream to cells. But cells are not responding to insulin calls (a condition known as insulin resistance) to absorb glucose.
  • These people are at higher risk to diabetic nephropathy (or diabetic kidney disease).
Cluster 4
Mild obesity-related diabetes (MOD)
  • Patients in this cluster are obese.
  • Younger in age.
  • No insulin resistance.
Cluster 5
Mild age-related diabetes (MARD)
  • Occur in the people during old-age.
  • Diabetes development due to small metabolic changes.

Researchers say their reclassification of diabetes can help healthcare professionals in making a better forecast of the risks associated with diabetes in a patient. The reclassification can also help healthcare professionals in providing individualized early treatments. Lead author of the study says they found an evidence which shows life-threatening complications associated with diabetes can be prevented with an early treatment of diabetes.


Re-categorization of diabetes into SAID, SIDD, SIRD, MOD and MARD for an early treatment of diabetes.

Lead author of the study was Professor Leif Groop, MD, PhD, Lund University - Diabetes Center, Malmoe, Sweden. The study findings were published online March 1, 2018, in The Lancet Diabetes and Endocrinology. Title of the article was "Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables." DOI : doi.org/10.1016/S2213-8587(18)30051-2




       
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Glutamic acid decarboxylase : Glutamic acid decarboxylase is an enzyme. Our pancreas requires this enzyme for the normal functioning of the pancreas. By mistake, our immune system makes antibodies to attack glutamic acid decarboxylase enzyme. These antibodies are called GAD antibodies. Studies show blood of 70 percent of the type 1 diabetes patients carries GAD antibodies.

GAD : See Glutamic acid decarboxylase.

 

 

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