A research group from the Swedish University of Lund developed a new five-group classification of diabetes. The work was conducted under the guidance of Dr. Emma Alquist. A description of the categories and an article about the work done were published on March 1 in the journal Lancet Diabetes & Endocrinology.
Until now, diabetes mellitus has been divided into three subgroups: gestational, type 1 and type 2. Gestational diabetes usually develops in women during pregnancy due to decreased sensitivity of cells to insulin. In type 1 diabetes mellitus, glucose metabolism and insulin deficiency are observed in patients, and in case of type 2 disease, the interaction of insulin with the cells of the body occurs. However, the scientists noted that this classification does not allow doctors to assess all the risks to the patient’s health, and tried to identify certain characteristics of the disease that would help doctors to more accurately assess the course of the disease.
In the new paper, Dr. Alquist proposed a five-group classification based on the health data of 8,980 patients with diabetes mellitus. All subjects were classified based on clinical characteristics such as age at diagnosis, BMI, glycosylated hemoglobin level , antibodies to glutamate decarboxylase(AT-GAD) and homeostatic assessment model 2 (HOMA2). Based on these parameters, the subjects were divided into 5 groups: severe autoimmune diabetes (type 1 diabetes according to the old system), severe diabetes with insulin deficiency (patients at risk for developing eye diseases and responded well to metformin), severe insulin-resistant diabetes (patients with high BMI and HOMA2-IR index, risk of kidney damage and development of non-alcoholic fatty liver disease), mild diabetes on a background of obesity and mild diabetes (about 40% of all subjects).
The scientists noted that groups 3, 4 and 5 responded well to the same treatment methods. The mutation of the TCF7L2 gene was observed in groups 2, 4 and 5, and in 1 and 2 groups the researchers found the greatest risk of diabetic ketoacidosis.