Ahora son 5 los tipos de Diabetes

5 Classifications of Diabetes Proposed

By Kelly Young

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Researchers have proposed five new ways to categorize patients with diabetes based on clinical and genetic parameters. Their work appears in the Lancet Diabetes & Endocrinology.

Scandinavian patients with newly diagnosed diabetes had the following elements collected at baseline: age at diagnosis, BMI, glutamate decarboxylase antibodies (GADA), hemoglobin A1c (HbA1c) levels, and homeostatic model assessment 2 to estimate beta-cell function (HOMA2-B) and insulin resistance (HOMA2-IR) using C-peptide concentrations. Based on these factors, patients were classified into one of the following clusters:

1. Severe autoimmune diabetes (formerly type 1 diabetes): affected 6% of patients in the derivation cohort; characteristics include early-onset disease, relatively low BMI, and GADA-positive
2. Severe insulin-deficient diabetes: 18% of patients; GADA-negative but similar to cluster 1; lowest HOMA2-B scores
3. Severe insulin-resistant diabetes: 15%; higher HOMA2-IR scores 
4. Mild obesity-related diabetes: 22%; obese, but not insulin resistant
5. Mild age-related diabetes: 39%; older than other clusters, but largely similar to cluster 4

The clusters were genetically distinct. Patients with severe insulin-deficient diabetes had the highest rates of retinopathy, while those with severe insulin-resistant diabetes had higher rates of end-stage renal disease and coronary events. The authors say these clusters "represent two new, severe forms of diabetes previously masked within type 2 diabetes." They add, "It would be reasonable to target individuals in these clusters with intensified treatment to prevent diabetic complications."

Lancet Diabetes & Endocrinology article (Free abstract)

Lancet Diabetes & Endocrinology comment (Subscription required)

Background: Physician's First Watch coverage of individualized glycemic control (Free)