Adult-onset diabetes consists of five types of disease that have different physiological and genetic profiles, rather than the traditional type 1 and 2 classification, say Scandinavian researchers, findings that could bring the promise of personalized medicine a step closer.
Gathering data on almost 15 000 patients from across five cohorts in Sweden and Finland, they found that using six standard measurements identified five clusters of patients with diabetes.
These divided into three severe and two mild forms of disease: one corresponding to type 1 diabetes and the remaining four representing subtypes of type 2 diabetes.
The clusters included one of very insulin-resistant individuals at significantly higher risk of diabetic nephropathy, another of relatively young insulin deficient individuals with poor metabolic control (high HbA1c), and a large group of elderly patients with the most benign disease course.
Crucially, treatment often did not correspond to the type of diabetes.
The research, published online March 1 in the Lancet Diabetes & Endocrinology, could have important implications not only for the diagnosis and management of diabetes but for future therapeutic guidance.
"Existing treatment guidelines are limited by the fact they respond to poor metabolic control when it has developed, but do not have the means to predict which patients will need intensified treatment," lead author Leif Groop, MD, PhD, Lund University Diabetes Center, Malmö, Sweden, and Folkhalsan Research Centre, Helsinki, Finland, said in a press release by the journal.
