Diabetes Has Five Distinct Types, Not Two: Study

[mannmade]

www.yahoo.com/news/diabetes-five-distinct-types-not-152739281.html

Health
Diabetes Has Five Distinct Types, Not Two: Study
Newsweek Katherine Hignett,Newsweek 11 hours ago

Most diabetes cases are split into two groups: type one and type two. A new study including nearly 15,000 diabetic patients suggests this decades-old distinction only tells part of the story. A new report divides diabetes mellitus into five separate conditions.

The advancement that could improve patient care. Because each group has different causes and complication risks, the authors of the study, published Thursday in the Lancet Diabetes and Endocrinology, believe the results are a “first step” towards precision medicine in diabetes.

Diabetes is a chronic metabolic disorder characterized by high blood sugar. Over time, it can lead to heart attack, limb amputation and blindness.

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Almost 10 percent of the U.S. population—30.3 million people—has a form of diabetes, according to the Centers for Disease Control and Prevention. Type 2 diabetes accounts for between 90 and 95 percent of these cases, and roughly 5 percent are type 1. Less common forms of the disorder include gestational diabetes and neonatal diabetes.

3_2_Insulin
Some diabetic patients use insulin to control their disorder. In this picture, a medical assistant administers a insulin to a patient in New Dehli, November 8, 2011. Sajjad Hussain/AFP/Getty Images

A complex picture

In type 1 diabetes, the body’s own immune system attacks beta cells, which produce insulin. This malfunction leaves the body without enough insulin to regulate blood sugar levels effectively.

Type 2 diabetes occurs when either the body does not produce enough of the hormone, or its insulin fails to work properly. Usually linked to obesity and a lack of exercise, type 2 diabetes may also have underlying genetic factors.

Researchers analyzed data including long-term blood glucose control for 14,775 diabetic patients. They identified five genetically distinct diabetes subgroups. Three were classified as “severe”, while two were “mild.”

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In the report, the authors identified these groups as clusters. The first cluster includes severe autoimmune diabetes, which is similar to traditional type 1. Patients with this form of diabetes are usually young and generally healthy but they struggle to make insulin as the result of an errant immune system.

Cluster 2 patients have what the authors call severe insulin-deficient diabetes. Similar to cluster 1 patients, this group includes young people of a healthy weight whose bodies do not produce insulin properly. The distinguishing feature in this cluster is that the problem is not triggered by a problem in the immune system. In addition, these patients have a higher risk of diabetic eye disease.

In cluster 3—severe insulin-resistant diabetes—patients are often overweight and their bodies have stopped responding properly to insulin. These patients are at a greater risk of kidney and liver disease.

Clusters 4 and 5 include mild diabetes. The former group includes patients who are very overweight but whose metabolism functions more normally. The latter group of patients develop a milder form of diabetes at an older age than the other groups.

More effective treatment prospects

3_2_Blood Glucose Moniter
Diabetic patients usually measure their glucose level with a drop of blood. Intel Free Press/Flickr

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The authors hope their work will eventually help medical professionals tailor treatment more effectively to patients in the different clusters, writing that it represents “a first step towards precision medicine in diabetes.”

“More accurately diagnosing diabetes could give us valuable insights into how it will develop over time,” said lead author, Leif Groop, who studies diabetes and endocrinology at Lund University Diabetes Centre in Sweden, in a statement, “allowing us to predict and treat complications before they develop.”

Victoria Salem, who researches investigative medicine at Imperial College London, told the BBC that specialists have long recognized that type 1 and type 2 were not particularly accurate classifications. The new study, she said, could help lead scientists towards a diabetes cure by changing the way they approach future study.

“What we need to start doing is thinking less about treating the end problem, which is high blood sugar, and more about what’s causing you to have your diabetes,” Salem said, according to the BBC. “Once we really understand that then we can start targeting the disease better with new drugs.”

The study did have limitations. Most notably, the population on which the findings are based does not necessarily represent the population of people diagnosed with the disease in real life. In the U.S., diabetes disproportionately affects Native Americans, Asian Indians and other ethnic minority groups. This paper was based in Scandinavian countries with relatively homogenous populations.

Expanding the classification system to include the entire at-risk population could lead to additional clusters, Salem told the BBC. “It may well be that worldwide there are 500 subgroups.”

[peppy]

When I read this post yesterday, I knew I had watched a good youtube video, talking about the same. The video I remember watching  was long (@ 30-45 mins,) and the presenter showed some of the laboratory data involved in their findings.

Today I went looking. Here is one short video talking about 5 types of diabetes. The information is out here.
www.youtube.com/watch?v=z9feVpQQKbE



added: this video did not mention diabetes insipidus.  I saw it once.

[joeypotsandpans]

Just read this after my post in the VDEX thread, case in point! Thanks for posting MM & Pep 

[dreamboatcruise]

peppy... interesting that the 5 listed in the video are not the same as the five listed in the article. Taking the two sources together it seems there are 7 different types. Of course the Type 1.5 in the video possibly could just be considered a patient having developed both T1 and T2.

[MnkdWASmyRtrmntPlan]

The way I read them, they are entirely different ways of categorizing ... Different perspectives.

5 Diabetes Types:
• 1 accounts for 5% - immune system attacks beta cells
• 1.5 = Type 2 with an autoimmune component.
• 2 accounts for 90 to 95% - don’t produce enough insulin, and/or it doesn’t work properly. Linked to obesity, lack of exercise and maybe genetic factors. Can stop responding to insulin.
• 3 = Alzheimers
• Gestational and Neonatal – during pregnancy

5 Db Clusters 1-5:
1. Severe autoimmune Db. Usually young & healthy.
2. Insulin-deficient Db. Young & healthy. Don’t produce insulin properly. Not an immune problem. High risk of eye disease.
3. Severe insulin-resistant Db. Overweight. Stop responding to insulin. Greater risk of kidney & liver disease.
4. Mild Db. Overweight, but metabolism functions normally.
5. Mild Db. Acquired at an older age than other clusters.


Type   Cluster
1        1
2        2, 3, 4, 5

The interesting thing is that Types 1 and 2 add up to 95 to 100% of all Db (90-95% + 5%).  So, that implies that Types 1.5 and 3 (Alzheimers) are both subcomponents of Types 1 and 2.  In other words, to have type 1.5 or 3, you have to have either Type 1 or 2 ... so ... you must be diabetic to get Alzheimers.  Which makes you wonder if you can take one more step here and imply that Diabetes causes Alzheimers.  Certainly not conclusive evidence here, but it builds on the evidence I have been reviewing.  And, most importantly for readers here, first, consider Afrezza's already huge market for T1 and T2 diabetics.  Once this news starts getting reported to the public (i.e., that diabetes causes alzheimers), adding the sales market of diabetes "preventative care" to Afrezza's already huge diabetic care sales market could increase Afrezza's sales market by a factor of 2 or 3.  Not just people who HAVE Alzheimers, but also everyone who is afraid of getting it.  As people age, they are not so scared about getting Db, so that factor is not compelling enough to drive patients to their doctor for an Afrezza Rx.  But they are scared sh!t-less about getting Alzheimers.  Talk about HUGE!!!

[peppy]

Mar 5, 2018 13:25:17 GMT -5 MnkdWASmyRtrmntPlan said:

The way I read them, they are entirely different ways of categorizing ... Different perspectives.

5 Diabetes Types:
• 1 accounts for 5% - immune system attacks beta cells
• 1.5 = Type 2 with an autoimmune component.
• 2 accounts for 90 to 95% - don’t produce enough insulin, and/or it doesn’t work properly. Linked to obesity, lack of exercise and maybe genetic factors. Can stop responding to insulin.
• 3 = Alzheimers
• Gestational and Neonatal – during pregnancy

5 Db Clusters 1-5:
1. Severe autoimmune Db. Usually young & healthy.
2. Insulin-deficient Db. Young & healthy. Don’t produce insulin properly. Not an immune problem. High risk of eye disease.
3. Severe insulin-resistant Db. Overweight. Stop responding to insulin. Greater risk of kidney & liver disease.
4. Mild Db. Overweight, but metabolism functions normally.
5. Mild Db. Acquired at an older age than other clusters.


Type   Cluster
1        1
2        2, 3, 4, 5

The interesting thing is that Types 1 and 2 add up to 95 to 100% of all Db (90-95% + 5%).  So, that implies that Types 1.5 and 3 (Alzheimers) are both subcomponents of Types 1 and 2.  In other words, to have type 1.5 or 3, you have to have either Type 1 or 2 ... so ... you must be diabetic to get Alzheimers.  Which makes you wonder if you can take one more step here and imply that Diabetes causes Alzheimers.  Certainly not conclusive evidence here, but it builds on the evidence I have been reviewing.  And, most importantly for readers here, first, consider Afrezza's already huge market for T1 and T2 diabetics.  Once this news starts getting reported to the public (i.e., that diabetes causes alzheimers), adding the sales market of diabetes "preventative care" to Afrezza's already huge diabetic care sales market could increase Afrezza's sales market by a factor of 2 or 3.  Not just people who HAVE Alzheimers, but also everyone who is afraid of getting it.  As people age, they are not so scared about getting Db, so that factor is not compelling enough to drive patients to their doctor for an Afrezza Rx.  But they are scared sh!t-less about getting Alzheimers.  Talk about HUGE!!!

quote:  you have to have either Type 1 or 2 ... so ... you must be diabetic to get Alzheimers.
Good try. Would it qualify, there are 1000's of elderly in nursing homes. Blood glucose levels could be obtained cheaply with a strip.
would not show cause, would show blood glucose statistics in Alzheimers?
I guess there is some data. 
www.google.com/search?client=safari&channel=mac_bm&source=hp&ei=SpWdWvOgMcb8jwTJqJLgAw&q=blood+glucose+levels+in+alzheimer%27s&oq=blood+glucose+levels+in+alzh&gs_l=psy-ab.1.0.33i22i29i30k1.1725.15374.0.17906.29.19.0.9.9.0.378.2034.16j1j1j1.19.0....0...1c.1.64.psy-ab..1.28.2130.0..0j46j35i39k1j0i131k1j0i20i264k1j0i131i20i264k1j0i46k1j0i22i30k1.0.XjZsrwlWizg

[peppy]

yikes
Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimer’s in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimer’s, and people who have diabetes and are treated with insulin are also more likely to get Alzheimer’s, suggesting elevated insulin plays a role in Alzheimer’s. In fact, many studies have found that elevated insulin, or “hyperinsulinemia,” significantly increases your risk of Alzheimer’s. On the other hand, people with type 1 diabetes, who don’t make insulin at all, are also thought to have a higher risk of Alzheimer’s. How could these both be true?

www.theatlantic.com/health/archive/2018/01/the-startling-link-between-sugar-and-alzheimers/551528/

Like solving world peace?

[MnkdWASmyRtrmntPlan]

Mar 5, 2018 14:39:41 GMT -5 peppy said:

yikes
Melissa Schilling, a professor at New York University, performed her own review of studies connecting diabetes to Alzheimer’s in 2016. She sought to reconcile two confusing trends. People who have type 2 diabetes are about twice as likely to get Alzheimer’s, and people who have diabetes and are treated with insulin are also more likely to get Alzheimer’s, suggesting elevated insulin plays a role in Alzheimer’s. In fact, many studies have found that elevated insulin, or “hyperinsulinemia,” significantly increases your risk of Alzheimer’s. On the other hand, people with type 1 diabetes, who don’t make insulin at all, are also thought to have a higher risk of Alzheimer’s. How could these both be true?

www.theatlantic.com/health/archive/2018/01/the-startling-link-between-sugar-and-alzheimers/551528/

Like solving world peace?

I don't see the leap that diabetics that get treated with insulin necessarily have elevated insulin.  It may be true.  Am I missing something?  Of course, that may happen with Insulin Resistant Type 2 pwd's.  But, see Peppy, you are going in the right direction.  These groups (types or clusters) are what need to be studied in alzheimer's patients.  Perhaps as you say, being an Insulin-Resistant Type 2 is a big factor in developing Alzheimer's, and being Type 1 is also a factor, but maybe obesity is not.  Maybe immune-system related Db is the only risk factor (remember, many T2's are also being found to have an immune system connection).  Who knows.  Immune system problem or not, obese or healthy weight, acquired when young or old, normally-functioning metabolism or not ... expansion or refinement of these classification systems may be the key to determining the primary risk factors for Alzheimer's.  Whatever the primary risk factors are, I have to believe that Afrezza will be the key tool in reducing those factors.

[dreamboatcruise]

Mar 5, 2018 13:25:17 GMT -5 MnkdWASmyRtrmntPlan said:

The interesting thing is that Types 1 and 2 add up to 95 to 100% of all Db (90-95% + 5%).  So, that implies that Types 1.5 and 3 (Alzheimers) are both subcomponents of Types 1 and 2.  In other words, to have type 1.5 or 3, you have to have either Type 1 or 2 ... so ... you must be diabetic to get Alzheimers.  Which makes you wonder if you can take one more step here and imply that Diabetes causes Alzheimers.  Certainly not conclusive evidence here, but it builds on the evidence I have been reviewing.  And, most importantly for readers here, first, consider Afrezza's already huge market for T1 and T2 diabetics.  Once this news starts getting reported to the public (i.e., that diabetes causes alzheimers), adding the sales market of diabetes "preventative care" to Afrezza's already huge diabetic care sales market could increase Afrezza's sales market by a factor of 2 or 3.  Not just people who HAVE Alzheimers, but also everyone who is afraid of getting it.  As people age, they are not so scared about getting Db, so that factor is not compelling enough to drive patients to their doctor for an Afrezza Rx.  But they are scared sh!t-less about getting Alzheimers.  Talk about HUGE!!!

Though IF the one researcher cited is correct about the causal link (quote below), exogenous insulin such as Afrezza would not be helpful in preventing Alzheimers.  However, I think it is far some settled what the causal link is if any.  I thought there have been some trial results that show nasal insulin delivery does provide cognitive benefit for those with dementia 

"Schilling posits this happens because of the insulin-degrading enzyme, a product of insulin that breaks down both insulin and amyloid proteins in the brain—the same proteins that clump up and lead to Alzheimer’s disease. People who don’t have enough insulin, like those whose bodies’ ability to produce insulin has been tapped out by diabetes, aren’t going to make enough of this enzyme to break up those brain clumps. Meanwhile, in people who use insulin to treat their diabetes and end up with a surplus of insulin, most of this enzyme gets used up breaking that insulin down, leaving not enough enzyme to address those amyloid brain clumps."

[sayhey24]

Mango has a zillion research papers on Alzheimers and its link to prolonged high sugar levels. I have no idea what the "cause" is but there is clearly a relation to prolonged high sugars. I think part of the problem is people with an A1c 6 and 6.5 are not even classified as diabetic so many with Alzheimer's were never considered diabetic.

Now as far as "5" types of diabetics, what can I say. Diabetes is a spectrum and each PWD is producing insulin on that spectrum and each PWD body requires different amounts of insulin which will vary by meal and day. The big questions are, are they under an active auto-immune attack or not and how much damage has been done. When you watch the LADA's they will have good days where they look non-diabetic and other days they produce little insulin.

Can you put a chart together which shows clusters along the spectrum, sure but does it matter? Get them the afrezza as the standard of care at first diagnosis and get the AGP to properly titrate on an individual basis. If they need a basal get them that too. Keep them in a non-diabetic TIR and over time some will see improvement and most will see progression stopped.