Beyond Type 1/Type 2: At least five different subcategories of diabetes, study shows

05 Mar 2018 --- Diabetes can be broken down into – at least – five groups. This goes beyond the classification of diabetes as being two-fold, Type 1 and Type 2, and could lead to significant future treatments tailored to patient’s needs. This is according to a study published in The Lancet Diabetes & Endocrinology Journal. “This is the step to more individualized medicine. We have been surprised at the immediate and enthusiastic response to this research from clinicians, for example,” Professor Leif Groop of Lund University Diabetes Centre tells NutritionInsight. 

In the study, researchers from Finland and Sweden examined 13,270 newly diagnosed diabetes patients, aged between 18 and 97. The results showed diabetes could be broken down into five groups: 

• Group 1: severe autoimmune diabetes is broadly the same as the classical type 1 – it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin.
• Group 2: severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 – they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault.
• Group 3: severe insulin-resistant diabetes patients were overweight and making insulin but their body was no longer responding to it.
• Group 4: mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3.
• Group 5: mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder.

This nuanced look at diabetes may explain why sufferers sometimes respond differently to diabetic treatments. The groups corresponded with patient characteristics (such as genes and weight) and largely prescribed different diabetic-related complications to be on the lookout for. 

Individuals in group 3 (most resistant to insulin) had significantly higher risks of diabetic kidney disease, while group 2 (insulin deficient) had the highest risk of retinopathy (loss of eye-sight). Importantly, these nuances were not accounted for in the patient’s treatments, as they had all been prescribed similar treatments, corresponding to their Type 1 or Type 2 diagnosis.

As Groop stated, this is only the first step in developing targeted treatments for patients. But with the enthusiastic response to the study, he added that the group “are developing clinical decision support that will be made available; however, this must be tested so it will not be available this year.”

Moreover, Diabetes UK weighed in on the study, with Senior Media Officer, Nzinga Cotton, telling NutritionInsight, "This research takes a promising step toward breaking down Type 2 diabetes in more detail, but we still need to know more about these subtypes before we can understand what this means for people living with the condition. For example, whether we’d find the same subtypes in people of different ethnicity or nationality." The study surely opens up an exciting space for further research and treatment.

The role of diet 
Of the five groups identified in the study, four related to Type 2 diabetes, making this study particularly relevant for the treatment and understanding of diabetes partly preventable strain.

Three in five cases of Type 2 can be prevented or delayed by making healthier choices, by helping people understand their own risk of developing the condition and by ensuring earlier diagnosis by monitoring high-risk groups.

“The two milder forms in the five groups, which comprise 55 percent of patients, can manage their condition with lifestyle advice and healthy diets,” Groop adds. Diet is an area where food manufacturers have input. The ideal diet Groop suggests is full of fibers, carbohydrates, vegetables and low in unhealthy fats.

So, diet is essential in the prevention of Type 2. The sheer scale of the disease – 4.6 million people are living with diabetes in the UK – means that not one sector alone can solve the problem. Yet, the importance to diet in the diseases onset and management invites the involvement of the Food and Beverage sector. 

As the demand for clean-label rises, sugar and salt levels are falling. The public sector has intervened, for example, the UN Sustainability bid, which included substantial reductions of sugar and salt in food products. Similarly, the highly-debated incoming sugar tax will reduce its prevalence in food. NutritionInsight has previously reported on diabetic targeted food products, and our sister website FoodIngredientsFirst has reported on the botanical ingredient opportunities for diabetes management. 

by Laxmi Haigh