Diabetes is a major public health concern around the world, affecting millions of people of all ages and backgrounds.

According to the World Health Organization (WHO), the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. Diabetes is a metabolic disorder that affects the way the body uses sugar (glucose), which is the primary source of energy for the body’s cells.

The most common types of diabetes are type 1 and type 2, but a new study suggests that diabetes may be five distinct diseases, not two.

The Study

The study, which was published in The Lancet Diabetes & Endocrinology, analyzed data from nearly 15,000 patients in Scandinavia.

The researchers used six different measurements to group the patients into subtypes, including age at diagnosis, body mass index (BMI), HbA1c (a blood test that measures average blood sugar levels), and the presence of autoimmune marker. The patients were then followed for an average of 4.3 years to see if the subtypes had any effect on their health outcomes, such as heart disease, kidney disease, and eye disease.

The Findings

The researchers identified five distinct subtypes of diabetes, which they named as follows:.

Cluster 1: Severe autoimmune diabetes
Cluster 2: Severe insulin-deficient diabetes
Cluster 3: Severe insulin-resistant diabetes
Cluster 4: Mild obesity-related diabetes
Cluster 5: Mild age-related diabetes

Each of these subtypes had distinct genetic and clinical characteristics, and responded differently to treatment. For example, patients in Cluster 1 had the highest risk of eye disease, while patients in Cluster 2 had the highest risk of kidney disease.

Patients in Cluster 3 had the highest risk of heart disease, while patients in Cluster 4 had the highest BMI and patients in Cluster 5 were the oldest at diagnosis.

The Implications

The findings of this study have important implications for the diagnosis and treatment of diabetes. Traditionally, diabetes has been classified into two broad categories: type 1 and type 2.

Type 1 diabetes is an autoimmune disorder that typically develops in childhood or early adulthood and requires treatment with insulin. Type 2 diabetes is a metabolic disorder that often develops later in life and is associated with obesity, physical inactivity, and a family history of diabetes.

However, this new study suggests that these categories may be too simplistic and do not capture the full range of clinical and genetic characteristics of diabetes.

By identifying distinct subtypes of diabetes, clinicians may be able to tailor treatment more effectively to individual patients.

For example, patients in Cluster 1 may benefit from immunomodulatory therapy, while patients in Cluster 2 may benefit from more aggressive insulin therapy. Patients in Cluster 3 may benefit from drugs that improve insulin sensitivity, while patients in Cluster 4 may benefit from lifestyle interventions, such as diet and exercise.

Patients in Cluster 5 may benefit from less intensive treatment and regular monitoring of their blood sugar levels.

The Limitations

While this study is an important step toward a more personalized approach to diabetes treatment, it is important to recognize its limitations.

The study was conducted in a relatively homogenous population in Scandinavia, and it is not clear if the findings will generalize to other populations. In addition, the study did not include a comparison group of healthy individuals, which makes it difficult to determine if the subtypes identified are specific to diabetes or are part of a larger metabolic spectrum.

The Future of Diabetes Research

Despite these limitations, the findings of this study provide an important foundation for future research on diabetes.

By identifying distinct subtypes of diabetes, researchers can investigate the underlying genetic and biochemical mechanisms that contribute to each subtype, and develop targeted therapies that address those mechanisms. For example, if a specific gene mutation is associated with Cluster 1 diabetes, researchers can investigate how that mutation affects insulin production and immune function, and develop drugs that target those pathways.

Overall, the study suggests that diabetes may be more complex and heterogeneous than previously thought, and that a personalized approach to diagnosis and treatment may be more effective than a one-size-fits-all approach.