Summary
Scandinavian research indicates there may not be simply two diabetic conditions (Type 1 and Type 2). Patients can be separated into five distinct clusters or sub-types, each with distinct symptoms, complications and possible treatments.
- Cluster 1: Severe Autoimmune Diabetes, broadly the same as the Type 1.
- Cluster 2: Severe Insulin-Deficient Diabetes, similar to above but where the immune system is not at fault.)
- Cluster 3: Severe Insulin-Resistant Diabetes, where patients are overweight and making insulin but their bodies no longer respond to it.
- Cluster 4: Mild Obesity-Related Diabetes, where people are overweight but metabolically more similar to normal.
- Cluster 5: Mild Age-Related Diabetes, where patients develop symptoms when older and the disease is typically milder.
Treating people in distinct groups differently might yield better outcomes, along the lines of personalised medicine.
Reference
Gallagher, J. (2018). Diabetes is actually five separate diseases, research suggests. London: BBC Health News, March 2nd 2018.
Further clarification from Bazian:
Reference
Are there actually 5 types of diabetes? London: NHS Choices; Behind the Headlines, March 2nd 2018.
This relates to:
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Reference
Ahlqvist, E. Storm, P. [and] Käräjämäki, A. [et al] (2018). Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes and Endocrinology. March 1st 2018. [Epub ahead of print].
Possibly of interest, regarding earlier diagnosis and intervention:
Reference
Therrien, A. (2018). Type-2 diabetes signs ‘detectable years before diagnosis’. London: BBC Health News, October 5th 2018.
Prevalence and Cost Trends
NHS Digital data on the increasing prevalence and costs of diabetes in England:
“…diabetes prescribing costs £1 billion per year, but it is estimated that the total cost to the NHS is over £10 billion per year… ”. Robin Hewings: Diabetes UK.
Reference
Ives, L. (2018). Diabetes prescriptions now cost NHS £1bn, figures show. London: BBC Health News, November 8th 2018.
Declining Incidence / Prevalence of Type 2 Diabetes?
A systematic review indicates that numbers of new Type 2 Diabetes cases may be stabilising, or falling recently:
Reference
Signs of a slowdown in new type 2 diabetes cases. London: BBC Health News, September 12th 2019.
This relates to:
Reference
Magliano, DJ. Islam, RM. [and] Barr ELM. [et al] (2019). Trends in incidence of total or type 2 diabetes: systematic review. BMJ. September 11th 2019; 366: l5003.
“ …increasing prevalence is partly driven by improved medical treatment and declining mortality”.
