Slashdot Mirror
Diabetes Is Actually Five Separate Diseases, Research Suggests (bbc.com)
An anonymous reader quotes a report from the BBC: Scientists say diabetes is five separate diseases, and treatment could be tailored to each form. Diabetes, or uncontrolled blood sugar levels, is normally split into type 1 and type 2. But researchers in Sweden and Finland think the more complicated picture they have uncovered will usher in an era of personalized medicine for diabetes. The study, by Lund University Diabetes Centre in Sweden and the Institute for Molecular Medicine Finland, looked at 14,775 patients including a detailed analysis of their blood. The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters:
Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 -- it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 -- they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder
Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 -- it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 -- they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder
Ubuntu and Mint are particularly virulent
There is more and more information coming out that Alzheimerâ(TM)s may be its own form of diabetes. https://www.ncbi.nlm.nih.gov/p...
With modern science we should be moving to treat the underlying problem and not the symptom. In many cases there are many underlying problems which can present the same or very similar symptoms. So we need to do the testing to understand what the real problem is and not just consider the symptom as the problem.
Studies and treatment protocols in western medicine are largely built on categories and statistics. Although you might think that more categories will result in better treatments/protocols, often it simply results in weaker statistics on the effectiveness of a particular protocol study and limited funds and patient pools to study variations of that protocol.
This is likely to be a boon for those who have the majority type of diabetes and likely a setback for those with less common types. Depends on which group you belong to...
Curiously enough, all forms of diabetes are amenable to at least partial treatment with one simple mechanism: stop eating sugar and and easily-digested starches. Some will require supplemental insulin, of course, but that small step will work wonders even for them.
Nice upgrade
Alzheimer's is also more than one disease, and brain plaques can form for a variety of different reasons along a similar metabolic pathway but to call them all diabetes is a bit retrograde.
It really irritates me how much the press can misinterpret scientific results. This is more a matter of classifying Type 2 as four new subtypes (since Type 1 is an autoimmune disease and "cluster 1" is the only cluster to contain autoimmune markers). If you're really interested in this, go check out the Medscape article about this (https://www.medscape.com/viewarticle/893305), which goes into a bit of detail and even calls them out for completely ignoring Type 3c (which though only recently classified, represents roughly 10% of those currently diagnosed as Type 2). There are actually 8+ currently recognized forms if you consolidate them as much as possible: * Type 1, which in turn breaks down into 1b (idiopatiic) and 1a (which has both rapid-onset and slow-onset aka LADA or Type 1.5) * Type 2 * Type 3c (pancreatogenic) * Gestational (both "normal" and autoimmune) * MODY (actually 12 separate genetic disorders) * Neonatal * Mitochondrial (Diabetes and Blindness) * Cystic Fibrosis Related Diabetes And as others have pointed out, it's been proposed that a form of Alzheimers relating to insulin resistance within the brain be reclassified as "Type 3".
Do you really need reason for beer? Wingman Brewers
Me, Me, Me, Me, aand Me.
Where does gestational diabetes fit into all this?
I was on Metformin for two years. Started at 500mg then increased to 2000mg. After two years I went through a personal crisis and decided to become a vegan and lost 40 lbs in 4 months. Now my blood sugars are normal and I stopped the metformin. Stupid doctor had me on pills for 2 years instead of telling me to quit being a fatty and lose weight.
Which is the really, really, really bad one.
So after decades of treating diabetics as either type 1 or 2, they wake up to the idea that things might be a little bit more complicated than that.
Yet, I an insulin-dependent diabetic am still nowhere to be found in their expanded categorisation.
I was ~35 when I was diagnosed with diabetes. This was well over a year after almost dying from acute pancreatitis.
It's well known in the literature (if not by common sense) that if the pancreas goes bonkers then there is a reasonable chance that the patient will probably become diabetic to some extent, since the pancreas is where insulin is produced. It was seemingly unknown to the cock holsters who treated me, though.
So another set of overpaid cock holsters come up with this staggering finding. /s
When I was diagnosed ~20 years ago, I grovelled around the 'net via Excite! and found a paper where the author identified maybe a dozen different types of diabetes including mine. Some 20 yrs later, they produce a considerably crappier paper and are lauded like they've split the fucking atom...
WTF? Read my sig.
The Machine stops.
It seems worthwhile to put this in perspective of general medical science and progress. In every age, doctors and scientists try to understand disease within the framework of contemporaneous knowledge. When new discoveries are made, everyone scrambles to reevaluate what they know with respect to their primary field of interest. This then propels extensive new nomenclatures of disease, new therapeutics, and new clinical treatment schemes. This is the normal flow of progress in medicine, since forever, but especially easy to trace the waves of discovery and development over the past two centuries.
As example, consider breast cancer, another disorder which, like diabetes, is of profound incidence, morbidity, death, and public health interest and funding. Before the 1850's, it was described by features on physical exam, and doctors knew and named them as "medullary", "scirrhous", and "ulcerated". After the 1850's, we best understood tissue pathology by what we saw under the microscope, and clinical histology became the mandatory standard by which diagnoses were made and treatments decided. Breast cancers were then designated as "ductal" or "lobular" depending on cell or structure of origin. In the past 30 years, discoveries from the proteomics and genomics world have identified genes and receptors which govern tumor behavior. What the cells look like under the microscope is not so prognostic as how they behave, and hormone and cytokine receptors and genes (ER, PR, HER2, BRCA) now rule the diagnosis. Whenever such new discoveries force a rethinking of diagnostic and treatment paradigms, there are usually international nomenclature conventions or committees which organize to bring some sense of logic and order and common language to the new and old systematics.
That is what this new diabetes research is about, getting more refined, more focused, more granular in understanding the pathogenesis of the disease. It makes up for profound deficiencies in the adequacy of old nomenclatures. Eons ago, there was just "diabetes", recognized by profuse urination (with a multitude of later complications). By the Middle Ages, distinction was made between diabetes in which the urine was either sweet or tasteless (yes indeed, taste test was the chem lab of its day). Sweet urine was then called diabetes mellitus (honey like), versus diabetes insipidus (tasteless) which we now know is due predominantly to ADH deficiency from the pituitary.
Diabetes was relatively uncommon before the 20th century. By mid century, increasing prevalence forced everyone to start rethinking the nature of the disease, inasmuch as various clinical subtypes and profiles were easily discerned. Anomalous forms such as "adult onset diabetes" and "non-insulin-dependent diabetes (niddm)" and then "obesity related diabetes" were obviously different than classical "true" diabetes, so a distinction had to be made with a more robust vocabulary. Thus, "Type 1" and "Type 2" diabetes, but these terms were adopted only circa 1990. But those two designations alone do not cover the spectrum of clinical presentations, for instance is niddm really the same as obese diabetes? Also, these designations do not address underlying physiological mechanisms. In a patient whose diabetes, blood sugar control, and life itself are dependent on exogenous therapeutically delivered insulin (iddm), is his disease because his pancreas not make insulin, or because it actually does make insulin, but peripheral cells do not have receptors to bind the insulin?
Recall a few basics about sugar and insulin. Cells use glucose as their primary fuel. The body has a complex multi-control system to regulate glucose levels in the blood so that cells get it when they need it, so that dietary sugars can be stored for later use, and stored carbon can be mobilized between feedings or during high demand. Insulin is central in this process, having multiple aspects of control and regulation within this complex machine. Its most immediate and profound function is, by bindi
There are too many self-appointed who have simple solutions for every complicated problem.
Thank you for setting the record straight.
This article has to be put in context. I do not know James Gallagher but in his opening statement `Scientists say diabetes is five separate diseases'is typical
of the kind of journalistic trash that abounds in modern society.
Apparently the people at Lund took the medical records of 15k people and ran
them through a statistical package. The output suggested five classifications of diabetes, rather than two or three previously. This presumably provides better rule of thumb for GPs in their treatment of individual patients: if the case fits in this box then give them those drugs.
This is epedemiology, or statistics if you like, with no biological understanding required. And certainly no scientist anywhere in sight.
Your comment implies that better medical treatment depends on advances in
fundamental research. By those over-worked, and under-paid, slaves
struggling in their laboratories who are trying to elucidate the underlying
processes that govern the functioning of all living things. And what do we
do? Do we provide them with the tools and time they need to get on with
their work? Or do we harass them continually for a cure for cancer, threaten
them with dismissal if they don't get funding, accuse them of not advancing
the careers of the university administration.
So beware when the BBC comes calling with their "Oh, so you work on stem
cells? Why don't we meet for a coffee and you can explain it to me". As any
football manager will confirm, journalists have little to no understanding of
anything but, like wayward children, they continue to vie for attention using
outrageous headlines like the one seen here.
Or is it 100 years since Type 1 and Type 2 diabetes were first defined/discovered? Whether 50 years or longer, how come all the so-called 'experts' doing 'research' never worked this out before? I bet that if anybody dared to come on Slashdot ten years ago and suggest that there were five types of diabetes, they would be ruthlessly attacked by the 'appeal to authority' cretins that infest this place...
learn the difference between illness and disease.