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A large scientific study concluded that there are not two but five different categories of diabetes, and that treatments could be adapted for each type of patient.
Diabetes is a chronic disease that according to the World Health Organization (WHO) affects 422 million people in the world, 8.5% of the adult population, according to 2014 data.
This disease also increases the risk of heart disease, stroke, blindness, kidney failure and amputations of the extremities.
Those who suffer from it can not control blood sugar levels, and are usually diagnosed in one of two general types of diabetes: type 1 or 2.
Type 1 diabetesIt is considered an autoimmune disease in which the body can not produce insulin and normally occurs in childhood.
The type 2 , the most common, usually appears in adulthood and is associated with an unhealthy lifestyle and obesity, since body fat can affect the behavior of insulin.
But a study with about 15,000 Finnish and Swedish patients, published in the journal The Lancet Diabetes and Endocrinology , has just offered a much more complex picture of the disease, which could trigger a new era of personalized treatment for diabetes.
5 genetically distinct types
Researchers say that the five identified subgroups have many differences between them and respond to different genetic types, including the age at which they occur and the varieties of risk and associated complications, such as kidney disease or blindness.
They analyzed the information of 8,980 patients from a Swedish registry diagnosed in adulthood and then confirmed the results with data from another 5,795 adults from three other databases in Finland and Sweden.
The research, from the Center for Diabetes of the University of Lund, in Sweden, and the Institute of Molecular Medicine of Finland, concluded that patients can be separated into these groups:
- Group 1: severe autoimmune diabetes . Broadly speaking, it is what is normally classified as type 1. It affects people when they are young and apparently healthy and is due to an autoimmune disease that makes insulin production impossible. As a result, there are not enough hormones to control the level of sugar in the blood.
- Group 2 : severe diabetes due to insulin deficiency . These patients are initially very similar to those in group 1 – they are also young, with apparently healthy weight and health – but have difficulty producing insulin. The difference is that there is no failure in the immune system but a defect in your beta cells, which “make” insulin. These patients have the highest risk of blindness.
- Group 3 : severe diabetes due to insulin resistance . Those who suffer in general are overweight and produce insulin but the body does not respond to the hormone. These patients have the highest risk of kidney disease.
- Group 4 : moderate diabetes related to obesity . Identified mainly in patients who are very overweight, but metabolically closer to normal values than those in group 3.
- Group 5 : moderate diabetes related to age . It is developed by patients who are significantly older than those of the other groups
The team of researchers says their findings explain why some patients with diabetes respond to treatments in a very different way than others.
They also ensure that this new classification can identify people who are at a higher risk of developing complications.
“This is extremely important, we are taking a real step towards precision medicine, ” Leif Groop, one of the academics who participated in the study, told the BBC.
Dr. Victoria Salem, a clinical researcher at Imperial College London, says that most diabetes specialists know that classifying the disease in type 1 and type 2 “is not a terribly accurate classification system.”
“This is definitely going to be the future of how we view diabetes as a disease,” he told the BBC.
But he added that the study will not immediately change how medicine is practiced.
Salem also noted that the research examined only the Scandinavian population but the risk of diabetes varies considerably between different parts of the world.
For example, in the United Kingdom, people from South Asia, from countries such as India, Bangladesh, Pakistan and Sri Lanka, are more likely to develop diabetes than the white population.
“It may be that there are 500 subgroups in the world, depending on the genes and the effect of local environments.”
” His analysis has five groups, but that can grow, ” he says.
Meanwhile, Emily Burns, of Diabetes UK, believes that understanding the disease better could help “personalize treatments and potentially reduce the risk of complications related to diabetes in the future.”
But he added that “we still need to know more about these subgroups in order to understand what impact this has for people who have the disease.”