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There are six clearly distinguishable subtypes in early stage diabetes, according to a new classification established by German researchers. Identifying a patient’s subtype can help identify risk and develop preventative strategies, they say.
The researchers analyzed the metabolism of nearly 900 people with prediabetes who were still considered healthy. The participants were part of two large German family and lifestyle studies conducted over 25 years in the city of Tübingen. The analysis was then extended to nearly 7,000 London residents.
The types of prediabetic diseases differ in blood sugar levels, insulin action and insulin secretion, body fat distribution, liver fat and genetic risk, said lead author Robert Wagner, MD, of the University of Tübingen. For example, although people in groups 1, 2, and 4 were healthy or relatively healthy despite certain risk factors, study participants in groups 3, 5, and 6 had specific health problems that were more likely to result in a later diagnosis of diabetes, Wagner and colleagues reported.
- People with subtype 3 produce too little insulin and are at high risk of developing diabetes.
- People in group 5 have severe fatty liver disease and a very high risk of diabetes because their body is resistant to the hypoglycemic effect of insulin.
- In subtype 6, the kidneys are damaged even before diabetes is diagnosed. Here, mortality is particularly high.
The new classification may help clinicians develop targeted prevention strategies, the researchers concluded.
Since 1980, the number of people with diabetes has quadrupled in the United States. In the long-term care population, the estimated prevalence of diabetes ranges from 25% to 34%, according to several studies.
The full results have been published in the journal Nature medicine.
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