Last month, researchers from Scandinavia identified five key types of diabetes. Diabetes is generally classified in the context of type 1 and type 2.
Type 1 diabetes causes the pancreas to create little or no insulin. The exact cause is unknown, although many believe it is related to genetics, environmental conditions or viruses. The body’s immune system starts attacking the insulin-producing cells and there is no cure.
Type 2 diabetes causes a resistance to insulin in the body or the body fails to produce enough insulin to maintain required glucose levels. Most experts believe that obesity, genetics, poor diet and a lack of exercise are causes of the condition.
However, the Scandinavian researchers believe that the existing two categories do not represent diabetes sufficiently. Dr Muhammad Hamed Farooqi, Director and Consultant Endocrinologist, Dubai Diabetes Centre (DDC), agrees that the reasons that someone contracts diabetes are manifold. “When we say that someone has diabetes, all we are saying is that their blood glucose level is high,” he says. “It is the same as when someone has a fever and their temperature is high — the causes could be multiple.”
Dr Farooqi sees type 1 and type 2 classifications for diabetes as a reflection of how our understanding of the condition has evolved. He refers to classifications as a vehicle for understanding the mechanisms of diabetes and a way of addressing the problems associated with the condition.
The five types of diabetes that the researchers identified are severe autoimmune diabetes, severe insulin-deficient diabetes, severe insulin-resistant diabetes, mild obesity-related diabetes and mild age-related diabetes. Dr Farooqi regards the new approach as a manifestation of how our understanding of patients has improved over time. “If you look at the Scandinavian research, they have not changed the diagnosis, but they are fine-tuning them into subcategories. If you start making sub-types, even with type 1 diabetes, we are still learning.”
Measuring antibodies
Dr Farooqi uses type 1 diabetes to contextualise the current level of understanding of the condition. “Over time, we figured out that in type 1 diabetes, the immune system is attacking the cells and killing them off.
We do not know exactly why this happens but we are able to measure that response and measure the antibody levels in terms of the attack. We can identify and pinpoint the antibodies that are attacking the insulin levels.
“I have a young female patient from Dubai. Her father asked if she has type 1 diabetes so we measured the antibodies and beyond doubt, at that level, we can tell them that the process is occurring in the body and that the patient has diabetes.”
Nevertheless, despite being able to identify and quantify the specific antibodies related to type 1 diabetes, professionals remain unable to pinpoint when a patient will start requiring insulin.
“This young patient, as an example, currently has an antibody level that is high but the cells that produce insulin are not all dead. Maybe only 10 per cent have died. This person is a type 1 diabetic but does not need insulin. A year from now or six months from now, I cannot predict how the battle will proceed. “However, we do know that at a certain point in time, she will need insulin.”
In the case of type 1 diabetes, the majority of cases involve children below the age of ten, although it can affect people of any age. For type 2 diabetes, the causes tend to be lifestyle-related, with obesity one of the key risk factors.
As with type 1, type 2 diabetes can manifest itself in numerous ways and affect many different types of people. “In type 2 diabetes, although you produce insulin resistance, which is related to obesity and genetics and those kind of things, the point is you will have whole range of people,” explains Dr Farooqi.
He refers to how he believes that the five new categories simply underline the importance of making sensible lifestyle choices to avoid type 2 diabetes. “If you look at what has been described, it reiterates the fact that the preventable thing, which is obesity, plays a very important role in the disease and if we take the right measures, in terms of diet, exercise and early diagnosis, then we can make a significant impact. As yet, the genetic aspect is not something we can change so the stress should be on the lifestyle modifications.”
Dr Farooqi defines the Scandinavian idea of five types of diabetes
1. Severe autoimmune diabetes
This is typical type 1 diabetes where the immune system is attacking and the fight is at a high level during the beginning and in a short span of time, the patient will move on to insulin.
2. Severe insulin-deficient diabetes
This is similar to severe autoimmune diabetes. However, in these patients we cannot find the reason why their insulin-producing cells went away. Here we can see that there are no insulin-producing cells but we cannot see that the antibodies are present.
There could be a number of reasons. There must be a mechanism for why the insulin producing cells die. It could be another antibody or it could be that cells are coming from outside and killing them off. We don’t even know if it’s something internal to the cells or something external.
3. Severe insulin-resistant diabetes
These are the cases where you may see symptoms such as obesity, and the patient is experiencing insulin resistance. It’s caused by whatever led to the obesity and on top of that, they have a genetic predisposition to type 2 diabetes. In this case, the insulin is not allowed to do its job because the body is resistant. It is the most common form of diabetes.
4. Mild obesity-related diabetes
Here the patient is less affected than they would be with severe insulin-resistant diabetes. This person is not as overweight as people suffering from severe insulin-related diabetes are and they do not display the same severity of symptoms.
5. Mild age-related diabetes
These people generally don’t have a severe form of diabetes but their age is older. Typically, the age bracket for type 2 diabetes is 30 to 40, when people are not that active and are putting on weight.
However, for mild age-related diabetes, they have the same symptoms except it’s not in their thirties or forties, it’s in later life. A study found that 40 per cent of people in their seventies and eighties suffer from this type of diabetes.
Nevertheless, different parts of the world have different activity levels and different diets. In the Scandinavian population, it may not be 40 per cent.
