Not all type 2 diabetics are equally at risk of late complications. A new classification based on 6 parameters and distinguishing 5 types of diabetes could make the course more predictable.
Diabetes is the fastest growing disease worldwide. 9 out of 10 illnesses occur in adulthood. They are referred to as type 2 diabetes and interpreted as a consequence of insulin resistance. One variant of adult-onset diabetes is LADA (“latent autoimmune diabetes in adults”), which initially begins as type 2 diabetes, but later becomes more similar to type 1 diabetes as a result of autoimmune disease, usually in childhood as a result of Destruction of beta cells usually has an abrupt onset and in contrast to type 2 diabetes is always insulin-dependent.
This classification, which is based solely on the determination of blood sugar, is classified by many diabetologists as unsatisfactory because there are “below the surface” large differences. In some patients, in addition to insulin resistance, beta-cell function is depleted relatively quickly, while others manage without insulin for life. Some patients develop kidney failure early on, others eye damage. Still others are primarily affected by myocardial infarction or amputations.
A team led by Leif Groop from the Diabetes Center of Lund University in Sweden is now proposing a reorganization. It is based on age at onset and body mass index on the following laboratory parameters that may be determined at a doctor’s visit: glutamate decarboxylase antibody (GADA; to identify patients with autoimmune diabetes), HbA1c (as blood glucose long term), HOMA 2B ( for assessment of beta cell function based on C-peptide concentration) and HOMA2 IR (for assessment of insulin sensitivity).
With the six parameters, Groop has been able to differentiate 5 different types of diabetes in the “Swedish All New Diabetics in Scania” cohort, which includes all diseases in the pure region of southern Sweden, three of which are severe and two of which are mild.