The 5 — Yes, 5 — Groups of Diabetes

Diabetes Care|May.13, 2019


Just how many types of diabetes are there? Easy question, right? Turns out that the answer's not that simple.

Recent diabetes research suggests that there may be more ways to diagnose diabetes than just type 1 and type 2. A study published in The Lancet has found there are actually five groups of diabetes — and understanding your specific type may make your diabetes management plan more successful down the line.

The current classifications of type 1 and type 2 diabetes haven't changed for more than 20 years. As diabetes becomes more common in our society, these findings coupled with the physicians observations/recommendations offer a better understanding of the underlying factors of diabetes and hope for improved and more personalised treatment.

The Study

The Lancet study looked at six measurable factors in nearly 15,000 people who were recently diagnosed with diabetes: age; body mass index (BMI); the presence of beta cell antibodies; level of metabolic control; measures of beta cell function; and insulin resistance. By looking at these diagnostic factors, researchers were able to define five subgroups of diabetes.

Group 1: Severe Autoimmune Diabetes (SAID)

This group is characterised by its autoimmune response to insulin; it overlaps with what's currently considered type 1 diabetes. When people have this type of diabetes, their immune system creates antibodies that destroy beta cells, the cells that produce insulin.

The diabetes management plan for people with type 1 diabetes includes close monitoring of blood glucose levels and insulin replacement, either through daily injections or the use of an insulin pump.

Group 2: Severe Insulin-Deficient Diabetes (SIDD)

In the study, people with this type of diabetes looked very similar to those with type 1: They were younger, of healthy weight, and their bodies didn't produce enough insulin. The difference is that people with SIDD didn't have any antibodies present, which means that their immune system wasn't the underlying cause of insulin deficiency. Instead, damage to insulin-producing cells caused their bodies to produce too little insulin.

This group had the highest risk of vision loss. The diabetes management plan for people with this type of diabetes is similar to those with type 1, but could also include oral medications.

Group 3: Severe Insulin-Resistant Diabetes (SIRD)

This diabetes subgroup is characterised by insulin resistance, which means that the body doesn't properly respond to its own insulin. People with SIRD are generally overweight, which further contributes to insulin resistance. The study found people with SIRD had a higher risk of kidney disease.

Researchers also found that the diabetes management plans for people with SIRD were the least effective. People with this type of diabetes stand to benefit the most from the new diagnostics and more intensive treatment that could come from this research.

Group 4: Mild Obesity-Related Diabetes (MOD)

People with this milder form of diabetes are generally very overweight and have some insulin resistance. Because the insulin resistance isn't as severe as it is with SIRD, this milder form of diabetes is believed to be caused entirely by obesity.

To lower your risk of getting this type of diabetes — and type 2 diabetes, in general — the National Health Portal recommends maintaining a BMI of no higher than 23.

Group 5: Mild Age-Related Diabetes (MARD)

People with MARD are elderly and have a milder form of diabetes than those who develop it during middle age. The study found that this was the most common form of diabetes. Although diabetes in the elderly is becoming more common, studies have shown that more people are living longer despite a diagnosis, which has been attributed to better education and research around treating and identifying the disease.

The Takeaway

Researchers aren't suggesting that it's time to revamp the way we diagnose different groups of diabetes. The study is, however, the first step in refining the understanding of diabetes and the possibilities for specific diabetes management plans for each type.

Over the years, your diabetes management plan — like you — will evolve. If you have diabetes, staying on top of the latest research and treatment advances is an important part of your diabetes management plan. Be sure to discuss what you learn with your doctor and ask if there are ways you can improve your current treatment.


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