A team of researchers from the University of Lund in Sweden has carried out a study in the south of the country with 13,720 patients (between 18 and 97 years old) newly diagnosed with diabetes, and the result has been a completely new classification of this disease , which instead of indicating the existence of two types of diabetes, as up to now, ensures that there are five.
The authors of the study, called ANDIS (All New Diabetics in Skane; “All new diabetics from Escania”, in Spanish) and published in the journal The Lancet Diabetes & Endocrinology , point out that this new classification helps to predict the risk of suffering complications serious consequences of the disease and to offer suggestions for a personalized treatment for each of the types.
The main difference from what exists today is that type 2 diabetes is actually subdivided into several subgroups. “This is the first step towards personalized diabetes management,” explains Leif Groop, a physician and professor specializing in diabetes and endocrinology at Lund University.
At present, 425 million people suffer from this disease throughout the planet – one in every eleven adults – and it is estimated that by 2045 this figure will increase to 629 million. In addition, it is necessary to take into account the complications and diseases associated with diabetes, such as kidney damage, retinopathy, osteoporosis and diseases of the heart and blood vessels, so it is essential to find better treatment options for it.
“The current diagnosis and classification of diabetes are insufficient and incapable of predicting future complications or the choice of treatment,” adds Professor Leif Groop, who initiated this study in the Scandinavian country and believes that its results represent a change to when foreseeing what this disease will be like in the future. “Today, diagnoses are carried out by measuring blood sugar. But a more precise diagnosis can be made by also taking into consideration the factors explained in ANDIS ”, he emphasizes.
Important for fine-tuning treatments
The study has been carried out since 2008, and has combined different types of measurements such as, for example, insulin resistance, insulin secretion, blood sugar levels and the age that the patient was at the beginning of the illness.
In addition to refining much more when making the classification – five different groups – the researchers have also discovered that these different groups suffer a greater or lesser risk of developing various secondary diseases . “This will allow earlier treatment to prevent complications in patients who are at increased risk of being affected,” says Emma Ahlqvist, associate professor and lead author of the publication.
Currently, diabetes is divided into type 1 (which affects approximately 10%), type 2 (between 85% and 90%) and other less common such as type LADA (or latent autoimmune diabetes of the adult), type MODY (characterized by the fact that the disease appears with less than 25 years) and secondary diabetes.
These are the five groups that the ANDIS study distinguishes (all of them named by their acronym in English):
Group 1, SAID (severe autoimmune diabetes): corresponds to type 1 and LADA type diabetes, and is characterized by the fact that patients begin to be so at an early age, have poor metabolic control and altered insulin production and due to presence of GADA antibodies.
Group 2, SIDD (severe insulin deficiency diabetes): suffered by people with high HbA1C (glycosylated hemoglobin), altered insulin secretion, and moderate insulin resistance. This group suffered the highest incidence of retinopathy.
Group 3, SIRD (severe insulin resistance diabetes): characterized by obesity and severe insulin resistance. In this group there was a higher incidence of kidney damage.
Group 4, MOD (mild obesity-related diabetes): includes obese patients who become ill at a relatively young age.
Group 5, MARD (mild age-related diabetes): is the group with the most people (about 40%), and is made up of the oldest individuals.
According to Professor Leif Groop, “patients with severe insulin resistance (those in Group 3) have the most to gain from the new diagnoses”, since they are currently receiving less adequate treatment.
The researchers have repeated the analysis in three other studies from Sweden and Finland . “The result exceeded our expectations and was closely related to the ANDIS analysis. The only difference was that Group 5 was larger in Finland than in Skåne. But the progression of the disease was very similar in both cases ”, explains Leif Groop.
They still have several studies underway to work on based on data they have already acquired and continue to recruit newly diagnosed diabetic patients. “The longer the period of time that the study is carried out, the more and better data we will collect,” argues Emma Ahlqvist. The researchers also plan to launch similar studies in China and India , with people of different ethnic backgrounds. “This will give us even better opportunities to tailor treatment to each individual,” he concludes.
