A recent blockbuster research study revealed a more precise breakdown of the types of diabetes, suggesting that instead of the recognized Types 1 and 2, there are actually five subsets of the disease.
But experts say that while the findings are promising, and may help doctors target treatments that are more personalized, the research isn’t necessarily new and is certainly not ready “for prime time.”
Scandinavian scientists reported in The Lancet Diabetes & Endocrinology journal that new classifications of this dreaded disease that affects 30 million Americans and is the 7th leading cause of death in the United States would help patients receive more personalized treatment.
Having diabetes means that a person’s blood sugar is too high. In Type 1 diabetes, which most often appears in childhood but can also occur later on in life, the body cannot make insulin—a hormone that helps glucose get into the cells.
In Type 2 diabetes, the most common, the body does not make or use insulin well. This condition occurs in middle age or older adults and is thought to be linked to lifestyle and obesity.
The Scandinavian researchers found that their diabetic subjects fell into five distinct clusters:
Cluster 1. Severe autoimmune diabetes. This group is similar to the classic Type 1.
Cluster 2. Severe insulin-deficient diabetes. Similar to Cluster 1 but the immune system wasn’t the cause of their insulin deficiently. This group has the highest risk of retinopathy, a complication of diabetes that can cause vision loss.
Cluster 3. Severe insulin-resistant diabetes. This occurs when people are overweight and highly insulin resistant which means that their bodies produce insulin but their cells don’t respond to it. This group has the highest risk of kidney disease.
Cluster 4. Mild obesity-related diabetes. People have a milder form of the disease without as many metabolic problems and they tend to be obese.
Cluster 5. Mild age-related diabetes. This form is similar to cluster 4 but people are older when they are diagnosed. This cluster is the most common form, affecting about 40 percent of the people in the study.
Dr. Daniel Bessesen, professor of medicine and program director of the Endocrinology Fellowship Program at the University of Colorado, tells Newsmax Health that “categorizing diabetes into groups will likely help with treatment,” but won’t likely mean big changes for most people.
“For example, people with Type 1 diabetes do not make insulin so they need to be treated with insulin,” he notes. “People with Type 2 diabetes can be treated with insulin but since their bodies make insulin and they tend to be insulin resistant, they can use other medications.”
Bessesen adds that now that we have a larger number of medications in our arsenal to treat diabetes, “truly personalized” treatment becomes more of a possibility.
“This study uses sophisticated genetic information combined with measures of physiology to categorize people with diabetes in a more detailed way than has been done before,” he says. “But for a strategy like this to be useful in clinical practice several things would need to happen.
“First of all, the measures they used would have to be standardized and accurate. Generally, a doctor in general practice would not be able to measure all the factors used in this study because of the methods used in their clinical lab.
“Secondly, a doctor would need specific cutoffs that could be used to categorize people and these cutoffs would have to work for their patients. African Americans, Asian Americans, Hispanics, men, women, old and young all have different genetic risk factors for diabetes.”
Dr. John Buse, director of the Diabetes Care Center at the University of North Carolina, agrees.
“The study group was from Scandinavia where the risk factors for Type 1 diabetes differ and may be greater than in America,” says Buse, former board member of the American Diabetes Association. “It is not practical to run sophisticated antibody tests that are expensive and not standardized on the general population. This study identified five sub-categories of diabetes but in fact, there may be 500 if we dig further into all the factors that contribute tom the disease.
“As a physician, if a patient presents to me as a Type 2 and does not respond to lifestyle changes and medication, then I would test for antibodies for type 1 and treat accordingly. We still have to monitor each patient and his or her progress no matter what the sub-type of the disease.”
Dr. Edna Tokayer, an endocrinologist from Boca Raton, Fla., tells Newsmax Health that the import of the new research isn’t entirely new.
“I treat all my patients as individuals,” she says. “There are many so-called ‘types’ of diabetes and the job I have is to tailor treatment to the patient, establishing who needs oral meds and who needs insulin. I also prescribe diet and exercise for all. A big part of my task is to figure out what is keeping someone from succeeding at gaining control of their blood sugar.
“Often it’s not just the physical factors but emotional ones as well. A patient may be feeling depressed and eating boxes of Twinkies to compensate which is like taking IV sugar into their bodies!”
The American Diabetes Association, in a press statement to Newsmax Health, acknowledges that personal attention should be given to each individual, regardless of the type or sub-type of their disease.
“The standards of diabetes care calls for an individualized plan, developed by a multidisciplinary health team, tailored to meet each person’s individual needs,” the ADA says.
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