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So… what type of diabetes do you have?

So…. you have been diagnosed with diabetes; but do you know what type of diabetes you have?  As it turns out, diabetes is not as simple as type 1 and type 2; but there are now five, yes five, proposed categories of diabetes.  These “types” now seem to be important to differentiate as treatment options are a bit different, depending on what type of diabetes you have.

The investigators in a very recent study have proposed these five new diabetes classifications with the idea that treatment can now be better “tailored” to the appropriate subtype. (1) 

These proposed new categories are: 

1. Severe autoimmune diabetes (formerly type

2. Severe insulin deficient diabetes

3. Severe insulin resistant diabetes

4. Mild obesity-related diabetes

5. Mild age-related diabetes

Although the new categories are not yet formally adopted by our medical boards; it is interesting to note that the researchers found complication risk to be quite different, depending on the sub-type of diabetes found in a given patient.  For example, group number three were found to have a higher risk of kidney disease than those in groups four and five. Group two had the highest risk of retinopathy.  As you can see, the main subtypes really are different forms of type 2 diabetes.

Currently, treatment strategies for patients with type 2 diabetes are clearcut, but do not allow for patient genetic variations of the disease, which are only now being looked at.  That means that future treatment plans will most likely be more dependent on which subtype of diabetes a patient is found to have.  As an example, if a patient is found to have mild obesity related diabetes, treatment strategies will most likely target weight reduction primarily.

These classifications are still very new; and more studies will be underway to see what is the best criteria to subdivide and diagnosis these new forms of diabetes.  It seems to be the future of medicine to individualize treatment paradigms based on the genetic makeup of a patient, along with all of the other patient characteristics such as family history, whether they are smokers,etc.

The impact of this study and how diabetes will be treated in the future can be huge.  It may help avoid using treatment strategies that don’t work well for certain patients.  It can be frustrating for people with diabetes to see a medication working for a friend or relative that doesn’t seem to work for them.  Genetic differences can account for this and will likely impact protocols in the years ahead.

The more common terms for different subgroups of diabetes are: Gestational, LADA, and MODY.

1. Gestational Diabetes: Caused by insulin resistance during pregnancy, is often treated with oral medication or insulin, and generally resolves after the delivery.

2. LADA: Latent Autoimmune Diabetes in Adults:  A form of T1D that occurs in adulthood-and is slow progressing.  It can take up to 5 years before it develops enough to necessitate insulin as opposed to oral meds or other forms of treatment.

3. MODY-Maturity Onset Diabetes of the Young: Very rare form of diabetes; requires genetic testing to confirm; often does not require insulin.

For now, a balanced healthy diet for everyone is a logical beginning coupled with consistent exercise, and of course, frequent monitoring of blood glucose.

And anyone who is injecting insulin should realize that their insulin can only do its job effectively when it is kept safe and treated right. Insulin in use should be kept at room temperature. This means that if you leave the house with your insulin, it must be stored correctly.

Don’t forget that at TempraMed we are here to protect you and your insulin from damaging temperatures and to keep you safe.

 

1.Ahlqvist E, Storm P, Käräjämäki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables [Published online March 1, 2018]. Lancet Diabetes Endocrinol. https://doi.org/10.1016/S2213-8587(18)30051-2.

           

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