Today there are four common types of diabetes: type 1 and type 2, latent autoimmune diabetes in adults (LADA), and gestational. And these classifications are plagued by an enormous amount of confusion, misconceptions, and even misdiagnosis between the types.
To complicate things further, a new study published in The Lancet Diabetes & Endocrinology is suggesting people with type 2 diabetes should be categorized into an additional four subgroups.
“This is the first step towards personalized treatment of diabetes,” said Leif Groop, a doctor and professor in the diabetes and endocrinology department at Lund University of Sweden.
Who falls into which group?
The new classification system for diabetes consists of five total subgroups. The first group is solely dedicated to autoimmune types of diabetes: type 1 and LADA.
The remaining four groups, however, pertain to all type 2 patients and categorizes them based on the severity of their insulin resistance, average blood sugar levels (A1c), whether they’re obese — and if so, their relative age, and whether their diabetes is due to old age.
The five new proposed subgroups of diabetes
- Group 1, severe autoimmune diabetes (SAID): type 1 diabetes and LADA, about 10 percent of those diagnosed
- Group 2, severe insulin-deficient diabetes (SIDD): higher A1c results, moderate insulin resistance, impaired insulin secretion, and the highest risk of retinopathy (eye disease)
- Group 3, severe insulin-resistant diabetes (SIRD): obese adults with severe insulin resistance, varying A1c levels, and the highest incidence of kidney disease
- Group 4, mild obesity-related diabetes (MOD): obese children and teens with varying HbA1c levels
- Group 5, mild age-related diabetes (MARD): the elderly, approximately 40 percent of those diagnosed
By looking beyond blood sugar levels, it’s suggested that this new approach could help those with diabetes receive the right treatment plan sooner. Many are forced to work through a variety of options until an effective treatment is found.
For instance, some may be first prescribed oral diabetes medications like metformin (the most prescribed diabetes drug in the United States in 2014), when their degree of insulin resistance can only be aided by insulin injections.
The delay in finding the right treatment plan can be months to years depending on the relationship and communication between doctor and patient, and how quickly the lack of efficacy is noted in their current treatment plan.
These delays place patients at an increased risk of complications from elevated blood sugar, including damage to eyesight, kidney function, blood vessels, peripheral nerves, as well as fingers and toes.
“Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment,” explained Groop.
A data-driven approach
Using approximately 13,000 newly diagnosed diabetes patients in their study, the researchers grouped participants based on the various factors. They found that the most insulin-resistant participants in Group 3 would benefit the most from this pinpointed and focused diagnostic system.
These patients, said Groop, are most often incorrectly treated.
The study was repeated three more times in Finland and Sweden, with consistent results in accurately grouping and pinpointing the most effective treatment options, as well as predicting which groups were at the highest risk for different complications.
The researchers intend to continue the same study in China and India.
Will this help doctors better treat patients?
One remaining question is how doctors can easily assess which group a patient ought to be in.
While some of the categories appear to be self-evident (the elderly, teens, and type 1 or LADA patients), determining whether a patient is severely or moderately insulin resistant isn’t something a doctor can easily do until various treatment protocols have failed.
And consequently, the doctor needs just as much time to find the right treatment plan for their patient after all.
Gretchen Becker — a medical journalist, author of “The First Year: Type 2 Diabetes,” and someone who’s lived with type 2 diabetes for over 20 years — told Healthline that the actual diagnostic process for this suggested protocol is far from usable for doctors.
“Only a statistician could [use this],” explained Becker after reviewing the actual study data herself. “SPSS is a statistical software. And it’s not clear if patients fell into distinct groups or if there were arbitrary cutoffs.”
For these new subgroups to be useful for the general healthcare system, this diagnostic tool still needs to become readily available and easy to use across the globe.
At the very least, Dr. Steve Parker, author of the book “The Advanced Mediterranean Diet” and blog Diabetic Mediterranean Diet, told Healthline, “it will remind physicians that not all type 1s and type 2s are alike. For instance, some need more attention to insulin resistance, others need insulin therapy started sooner than others.”
“The proposed classification system depends on measurement of insulin resistance and pancreas beta cell function,” added Dr. Parker.
“A large majority of people with diabetes in the U.S. are not even being tested for these now. The reason is that while the tests are reasonably accurate for testing large groups of people, they are less accurate when testing an individual patient.”
The International Diabetes Federation (IDF) reports that today’s global diabetes population is 425 million people — and rising — which means the burden on healthcare systems to better care for its diabetes population is also increasing dramatically.
The IDF estimates that number will increase by another 200 million in the next 20 years.