Scientist Have Just Realized there are FIVE type of Diabetes

[Little Bluestem]

That's what I have been hearing on the radio all evening. And here we thought diabetes was a well-understood disorder.

 

[Valentijn]

From a BBC article:

Cluster 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
Cluster 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
Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
Cluster 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
Cluster 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 isn't really news. Cluster 1 = Type 1. Cluster 2 is genetic diabetes, caused by mutations on certain genes. Clusters 3-5 are Type 2 with varying levels of insulin resistance. There's also diabetes caused by mitochondrial disease or other dysfunction.

I think what they've really done is subgroup the metabolic aspects in Type 2 patients, and they, their university, and/or the press (probably all three) have created an excess of hype by claiming they've discovered something revolutionary. And the reality is that patients with different issues are already being medicated differently. Doctors generally don't care if someone has diabetes due to autoimmunity or not - they get labeled based on whether they need insulin or not.

The only potential difference would be how quickly a diabetes patient gets a treatment which is useful for them. But I don't see how this paper is going to change the cost analyses which have created a standard approach based on a lot of assumptions. If you're fat or over a certain age, it's assumed to be Type 2. These assumptions are made precisely because it's cheaper than testing, so at best finding additional subtypes is going to result in more nuanced assumptions without any improvement in actual diagnostics.

So the process is still going to be "make a guess, try the first thing on the list, and try something else if it doesn't work." With the added bonus that it takes 3-6 months to see if something works in the UK or Netherlands, because home testing with a glucose meter isn't funded or recommended for (presumed) non-autoimmune diabetics.

 

[Amw66]

Phosphate diabetes?

 

[Invisible Woman]

If you're fat or over a certain age, it's assumed to be Type 2. These assumptions are made precisely because it's cheaper than testing,

..or even if you're just over 50. My slim fit 58 year old neighbour was diagnosed with type 2. His wife nagged him into going back for further investigation and then to go back again.

Turns out pancreatic cancer will cause that to.

However, in the treat 'em and street 'em high volume churn, most docs will just assume a it's lifestyle issue rather than a symptom.

 

[AndyPandy]

Skinny type 2 diagnosed in my thirties.

 

[Awol]

I haven't read the study, just saw this article and thought it was interesting in terms of subtypes in a disease and targeting treatments etc.: https://www.medicalnewstoday.com/articles/321097.php

"Adults with diabetes could benefit from better treatment if the condition was categorized into five types, rather than just two. This is the conclusion of a new study published in The Lancet Diabetes & Endocrinology."