Five new subtypes of type 2 diabetes

    

    

Doctors newspaper online, 30.06.2019

    

        
        
        

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diagnosis

Researchers now suggest five subtypes of type 2 diabetes. Specific therapies should be developed for each form.

Diabetes has been largely divided into Type 1 and 2. Clarification of the shapes could improve treatment. One year ago, Swedish researchers first made a subdivision ( Lancet Diab & Endocrinol 2018; 6: 361 ). The team had analyzed data from 14,775 recently diagnosed adult diabetics. Based on diagnostic age, BMI, HbA _1c beta cell function, insulin resistance, and autoantibodies, they suggest five diabetes subgroups in adults.

This classification has already been confirmed by other researchers, and there are first suggestions for specific therapies. Affected of the first two types need insulin; they are grouped under "Severe Insulin Deficient Diabetes" (SIDD):

• Severe autoimmune diabetes (mostly LADA diabetes); Manifestation mostly in younger adults. Beta cells destroyed, no insulin production (proportion: 6-15 percent).
• Severe insulin deficiency (similar to autoimmune diabetes). Affected are usually young and slim; no autoantibodies, the immune system is not faulty (9-20 percent).

More subgroups

• "Severe insulin-resistant diabetes" (SIRD): severe insulin resistance, mostly overweight, no adequate response to insulin, high risk of nephropathy (11-17 percent). Proposed therapy with metformin or GLP-1 agonists, for kidney protection SGLT2 and ACE inhibitors.
• Moderate Obesity Diabetes (MOD): Affected are mostly severely overweight, but the metabolism is less disturbed than in patients first three groups (18-23 percent).
• Moderate age-related diabetes (MARD): Symptoms begin in comparison to the other groups at a higher age (39-47 percent).

In the last two forms, lifestyle changes have been suggested as therapy.

According to the Swedish researchers, all five forms are genetically distinct. It is therefore more a matter of different types than disease stages. In addition, the study found that many patients had not been adequately treated. Many patients of the two SIDD groups did not receive insulin on manifestation. (cis)

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