Building on ground-breaking results from IMI diabetes projects, scientists are now working on a software tool that would identify what subtype of diabetes a patient has, and suggest which treatment would work best for them
For many years, the medical world has recognised two main types of diabetes: type 1 diabetes, which used to be called juvenile-onset or insulin-dependent diabetes and usually develops in children or young adults, and type 2 diabetes, which used to be called adult-onset or non-insulin-dependent diabetes and is more likely to occur in people who are over the age of 40, overweight and have a family history of diabetes.
However, research funded in part by IMI through the BEAt-DKD and RHAPSODY projects paints a different picture, suggesting that there are not two subtypes of diabetes, but five.
Writing in The Lancet Diabetes and Endocrinology in 2018, the researchers explain how they arrived at this conclusion after a data-driven cluster analysis of six readily measured variables in the clinic, such as blood sugar levels, insulin resistance, insulin secretion, BMI and age in over 14 000 newly-diagnosed diabetes patients. Their analyses revealed five distinct clusters of patients with significantly different patient characteristics and risk of diabetic complications.
- Group 1, SAID (severe autoimmune diabetes) essentially corresponds to type 1 diabetes and LADA (latent autoimmune diabetes in adults) and is characterised by onset at young age, poor metabolic control, and impaired insulin production
- Group 2, SIDD (severe insulin-deficient diabetes) includes people with impaired insulin secretion and moderate insulin resistance. Group 2 had the highest prevalence of diabetic retinopathy
- Group 3, SIRD (severe insulin-resistant diabetes) is characterised by obesity and severe insulin resistance. Group 3 had the highest risk of developing chronic kidney disease
- Group 4, MOD (mild obesity-related diabetes) includes obese patients who fall ill at a relatively young age
- Group 5, MARD (mild age-related diabetes) is the largest group (about 40 %) and consists of the most elderly patients.
The scientists didn’t stop there but validated these initial findings in additional patient populations, including cohorts of different ethnicities and several intervention studies are currently on-going to test the effects of different treatments on the different diabetes subtypes.
Meanwhile, investigators have developed a software tool currently used for research purposes and soon to be implemented in the clinic to allow doctors to identify which diabetes subtype the patient has. The tool is still under development with regards to providing feed-back to the doctor on treatment recommendation, but is available to others upon request.
The researchers have received funding from other sources beyond IMI to carry out these additional studies, which are time consuming and expensive. All in all, this story shows how IMI projects can deliver ground-breaking results, validate them, and turn them into a tool that can hopefully assist in providing the right treatment for the right patient at the right time.
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Read the 2018 paper in The Lancet Diabetes and Endocrinology and the accompanying press release from Lund University
Visit the RHAPSODY project’s web pages for further work on the characterization of the new diabetes clusters