Diabetes is basically a disease characterized by 'uncontrolled blood sugar levels' and so far it is generally divided into two types - type 1 and type 2.
But researchers in Sweden and Finland think they've uncovered a more complex picture of diabetes and may lead to individualized treatments for the disease.
Experts say this research could usher in a new era of diabetes treatment in the future, but it may take more time to see changes in current treatments.
One in 11 people worldwide has diabetes - and once diagnosed, patients are at increased risk of heart attack, stroke or brain hemorrhage, blindness, kidney failure and amputation.
Type 1 diabetes is a disease related to the human immune system. It attacks the body's ability to make insulin, or beta cells, resulting in insufficient production of the hormone needed to control blood sugar levels.
Type 2, on the other hand, is thought to be a disease related to an uncontrolled lifestyle, where excess body fat interferes with insulin action.
The latest study on diabetes was conducted by Sweden's Land University Diabetes Center and Finland's Institute for Molecular Medicine. And it monitored 14,775 patients, detailed analysis of their blood.
The study results were published in Lancet Diabetes and Endocrinology. It showed that diabetic patients can be divided into five distinct clusters.
Cluster 1 - This is type 1 severe autoimmune diabetes with thick patches, which affects people when they are young and appear to be healthy. People with this diabetes do not produce insulin in their body.
Cluster 2 – These are insulin-deficient diabetic patients who initially appear similar to cluster 1 patient. They are young, their weight is under control, but struggle to produce insulin - even though their immune system has no lumps.
Cluster 3 – These are patients with severe insulin-resistant diabetes who are usually overweight. They are making insulin in the body, but their body is not responding to that insulin.
Cluster 4 – This is weight-related mild-type diabetes, which occurs in morbidly obese people. Such people are closer to normal people than cluster 3 people in terms of metabolism.
Cluster 5 - age-related mild diabetes, which occurs in people with this type as they age. That is, these patients are older than people in the other groups, but their diabetes levels are low.
Professor Leaf, one of the research team, said: "This is very important, we are taking a step forward in giving patients exactly the right medicine."
He said that type 3 diabetes, which is severe, can be treated more aggressively than the other two types. Patients with cluster 2 type can now be classified as type 2, because they do not have autoimmune disease.
The study, however, suggests that their disease may be caused by a defect in their beta-cells - not because they are too fat. And they need to be treated like patients who are now classified as type 1.
Cluster 2 patients have the highest risk of blindness, and cluster 3 patients have a higher risk of developing kidney-related disease – so patients in some clusters may benefit from more testing.
London's Imperial College consultant and clinical scientist Dr. Victoria Salem said most experts knew that the classification of diabetes into type 1 and type 2 was "not very accurate".
"There is no doubt that this research will help shape how we think about diabetes in the future," he said.
But he also cautioned that there will be no change in the treatment of diabetes today.
This study was conducted in Scandinavia. On the other hand, the risk of diabetes varies from country to country. For example, the risk of this disease is relatively high in South Asia.
Dr. Salem said, "A lot is still unknown." "It may be that there are 500 subgroups of diabetes worldwide due to genes and local environment."
"The researchers' analysis found five clusters, but this number may increase," says the scientist.
Professor Suresh Kumar, from Warwick Medical School, said: "This is definitely just a first step. We need to know if we can get better results by treating them differently."
A better understanding of the disease "can help individualize treatment and reduce the risk of future diabetes-related complications," says Emily Burns.
"This study shows great promise for better understanding type 2 diabetes, but we need to know better about the subgroups before we can understand how it will benefit people with diabetes," he added.
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