A Swedish research team has divided type 2 diabetes patients into smaller homogeneous groups that are clinically useful for predicting disease progression and selecting therapy.
Professor Emma Ahlqvist of the Lund University Diabetes Centre in Sweden presented the subtypes during the International Diabetes Federation (IDF) Conference 2019 in Busan.
|Professor Emma Ahlqvist of the Lund University Diabetes Centre in Sweden explains the five subgroups of type 2 diabetes, during the International Diabetes Federation (IDF) Conference 2019 at BEXCO in Busan on Tuesday.|
"We used all new diabetic patients in Scania, a town in Sweden, as a cohort and used various cluster variables -- presence of glutamic acid decarboxylase 65-kilodalton isoform (GAD65) antibody, hemoglobin A1c (HbA1c) at diagnosis, body mass index, age at diagnosis, insulin secretion and insulin resistance – to obtain the subgroup,” Ahlqvist said.
As a result, the team was able to divide patients into five subgroups with different characteristics and progression.
The five subgroups are severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), moderate obesity-related diabetes (MOD), and moderate age-related diabetes (MARD). Ahlqvist divided the five subgroups into three severe forms of diabetes –SAID, SIDD, SIRD -- and two mild forms of diabetes – MOD and MARD.
In detail, patients classified as SAID had GAD antibodies, low insulin secretion, and poor metabolic control and accounted for six percent of the subgroup. Patients classified as SIDD had low insulin secretion and poor metabolic control and had the highest risk of diabetic retinopathy and neuropathy and accounted for 18 percent of the subgroup. They were also most likely to receive insulin and a second oral treatment to control their symptoms.
Those in the SIRD group had insulin resistance, obesity, and late-onset of diabetes and had the highest risk of diabetic kidney disease and non-alcoholic fatty liver disease and accounted for 15 percent of the subgroup.
In groups with moderate forms of diabetes, patients classified as MOD had obesity and early onset are relatively young with the highest BMI among the subgroups and accounted for 22 percent of the subgroup.
MARD patients accounted for the largest portion of the subgroup with 39 percent and had the least amount of complication risk. They were also the least likely to receive insulin or second oral medication
“The subgroup is important as it could be useful in the clinic to predict the risk of complication and guide the choice of medication,” Ahlqvist said. “For example, SIDD and SIRD patients develop complications very early and would benefit from early identification and treatment.”
The team is also studying response to treatment for different subgroups and has acquired some data on which treatment is most effective in each group, she added.
Ahlqvist stressed, however, the research is in the beginning phase and hopes that the team will be able to provide more data in the future.
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