Do you have diabetes? If so are you a MOD? Not the type that used to scoot down to Brighton of a Bank Holiday but someone with Mild Obesity-related Diabetes.
In ground-breaking research that looks set to change the way doctors view diabetes forever, Swedish researchers have identified not just the two main types of the disease currently recognised, but five new subtypes in adults.
‘Type 1 and type 2 diabetes are very different entities, and with over 3.6 million people diagnosed with the disease in the UK, we now think it may be too simplistic to divide into just two types,’ comments Dr Emily Burns, Head of Research Communications at Diabetes UK.
The new subtypes are each marked by different features and likelihood of complications.
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1. Severe-autoimmune diabetes (SAID)
What is SAID? Corresponds most closely to what we currently call type 1 and to an adult onset autoimmune form of diabetes. The immune system attacks pancreatic cells stopping insulin production. Autoantibodies in the bloodstream are a sign of this. It strikes early in adult life and affects slim people.
Risk of: Ketoacidosis, which happens when the body begins to break down fat as fuel leading acids called ketones to build up in the bloodstream.
Treatment for SAID: Insulin injections.
2. Severe insulin-deficient diabetes (SIDD)
What is SIDD? A severe type of diabetes, thought currently to be ‘masked’ by the label type 2. Sufferers are insulin deficient but don’t have the autoimmune antibodies.
Risk of: The diabetes-linked eye disease, retinopathy.
Treatment for SIDD: Insulin injections + lifestyle changes. Although this group had the highest proportion of patients on the anti-diabetes drug, metformin, the researchers say sufferers do better by going on insulin early.
3. Severe insulin resistant diabetes (SIRD)
What is SIRD? Another severe form of the disease previously ‘hidden’ under the umbrella of type 2. Sufferers are highly insulin resistant, when the body makes but can’t use insulin properly. They are likely to have a high BMI (Body Mass Index).
Risk of: Serious kidney damage and non-alcoholic fatty liver disease (NAFLD).
Treatment for SIRD: Metformin + lifestyle changes.
4. Mild obesity-related diabetes (MOD)
What is MOD? A milder form of diabetes, sufferers have a high BMI (over 30) but are not insulin resistant.
Risk of: Lower risk of complications.
Treatment for MOD: Metformin + lifestyle changes.
5. Mild age-related diabetes (MARD)
What is MARD: Another milder form of the disease that affects older people. Most of those studied (almost four in ten) had this type and their ‘metabolic profile’ – i.e. blood glucose level, levels of blood chemicals such as sodium, potassium, chloride, and bicarbonate, fluid balance, kidney and liver function - was healthier than the other types.
Risk of: Lower risk of complications.
Treatment for MARD: Metformin + lifestyle changes.
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The subtypes are not definitive but lots of research is now underway to try and nail them down. The researchers also discovered that each type has a different genetic signature opening up the prospect of earlier diagnosis.
What does this mean to you if you have diabetes?
It is unlikely to change what happens at the doctor’s surgery yet. But in the not-too-distant future it could enable doctors to fine-tune treatment in a way that is currently impossible. Two apps – one for doctors and one for people with diabetes - are already under development and could be on the market within two to three years.
‘We hope it will lead to a much more tailored approach to diabetes care,’ observes Dr Burns. An exciting prospect - so watch this space.
Note: The research findings apply to adults over 18 years.