Diabetes is actually five separate diseases, research suggests

[everydayupsanddowns]

It's also missing the various MODY types. But those are defined as single genetic defects so I guess they are reasonably well defined.

That's the first thing I thought of too!

 

[everydayupsanddowns]

I have read that GAD is not always positive.

It was really interesting to see how weak the evidence was for various antibody and cpeptide testing when we were reviewing it for the NICE guidelines. Some people with T2 (who may be, but do not *seem* to be misclassified) can exhibit some antibodies... meanwhile some people who have had "classic" T1 for years and killed off all their beta cells are no longer producing much if anything by way of antibodies.

There are real risks of false positives and false negatives it seems. The better option seems to be to measure at least 2 of the different antibodies, and to do so as soon as possible. But essentially, the clearest way to diagnose is still to use the clinical factors of the presentation / onset / family history / etc etc.

 

[Mark T]

That's the first thing I thought of too!

Although the introduction to the paper does make reference to MODY:

Diabetes is the fastest increasing disease worldwide and a substantial threat to human health.1 Existing treatment strategies have been unable to stop the progressive course of the disease and prevent development of chronic diabetic complications. One explanation for these shortcomings is that diagnosis of diabetes is based on measurement of only one metabolite, glucose, but the disease is heterogeneous with regard to clinical presentation and progression.
Diabetes classification into type 1 and type 2 diabetes relies primarily on the presence (type 1 diabetes) or absence (type 2 diabetes) of autoantibodies against pancreatic islet β-cell antigens and age at diagnosis (younger for type 1 diabetes). With this approach, 75–85% of patients are classified as having type 2 diabetes. A third subgroup, latent autoimmune diabetes in adults (LADA; affecting <10% of people with diabetes), defined by the presence of glutamic acid decarboxylase antibodies (GADA), is phenotypically indistinguishable from type 2 diabetes at diagnosis, but becomes increasingly similar to type 1 diabetes over time.2 With the introduction of gene sequencing in clinical diagnostics, several rare monogenic forms of diabetes were described, including maturity onset diabetes of the young and neonatal diabetes.3,4
Existing treatment guidelines are limited by the fact they respond to poor metabolic control when it has developed, but do not have means to predict which patients will need intensified treatment. Evidence suggests that early treatment is crucial for prevention of life-shortening complications because target tissues seem to remember poor metabolic control decades later (so-called metabolic memory).5,6
A refined classification could provide a powerful tool to identify at diagnosis those at greatest risk of complications and enable individualised treatment regimens in the
same way as genetic diagnosis of monogenic diabetes guides clinicians to optimal treatment.7 With this aim, we present a novel diabetes classification based on
unsupervised, data-driven cluster analysis of six commonly measured variables and compare it metabolically, genetically, and clinically to the current classification in four separate populations from Sweden and Finland.

 

[trophywench]

The article in the Guardian is a bit more detailed, for instance they did the work in Norway but it was checked out with similar databases in Finland and Sweden - oh OK, all Scandinavians look the same to me ......

It wouldn't be a bad idea to know who was likely to get eye problems - but there again would I the patient, actually want to know that especially if I'm a teenager about to embark on the licensed premises scene with my mates, would it encourage me to look after myself a bit better? I might like very much to know that at 67 though, considering I haven't really had any yet (I don't regard astigmatism or cataracts as any prob)

However if they could relatively easily/cheaply differentiate between the people who 'are old overweight and obviously made bad lifestyle choices' that they need insulin jabs PDQ and DIDN'T 'bring it on themselves' and just need more and more tablets and a cursory blood test whenever we can be bothered - I think that would be blooming marvellous.

I live in HOPE, me !

 

[Matt Cycle]

meanwhile some people who have had "classic" T1 for years and killed off all their beta cells are no longer producing much if anything by way of antibodies

That's interesting Mike. As my consultant said this morning the antibody tests they did were clear or very small amounts (not sure what that means) but as I mentioned the C-peptide was not detectable. He said that's because after such along time the antibodies wouldn't show up because the beta cells are no more.

 

[grovesy]

It was really interesting to see how weak the evidence was for various antibody and cpeptide testing when we were reviewing it for the NICE guidelines. Some people with T2 (who may be, but do not *seem* to be misclassified) can exhibit some antibodies... meanwhile some people who have had "classic" T1 for years and killed off all their beta cells are no longer producing much if anything by way of antibodies.

There are real risks of false positives and false negatives it seems. The better option seems to be to measure at least 2 of the different antibodies, and to do so as soon as possible. But essentially, the clearest way to diagnose is still to use the clinical factors of the presentation / onset / family history / etc etc.

Yeah.

 

[SB2015]

That's interesting Mike. As my consultant said this morning the antibody tests they did were clear or very small amounts (not sure what that means) but as I mentioned the C-peptide was not detectable. He said that's because after such along time the antibodies wouldn't show up because the beta cells are no more.

That seems to make sense. Once the Beta cells have been obliterated there is not much for the GAD antibodies to do, so they will push off. Whatever my Diabetes is called I know I am T1 of some sort, and I need insulin.

 

[mikeyB]

Yup, my consultant just based the diagnosis on clinical symptoms and signs. Didn’t bother with blood tests, presumably for that reason. I suppose technically I’m a LADA, but I haven’t gone rusty yet.

 

[Robin]

Yup, my consultant just based the diagnosis on clinical symptoms and signs. Didn’t bother with blood tests, presumably for that reason. I suppose technically I’m a LADA, but I haven’t gone rusty yet.

When I was diagnosed at the hospital, they first put me down as LADA, then the next time they went, they said they'd decided that the term wasn't particularly helpful, and put me down as 'Autoimmune'. They said they were trying hard not to call people 'Type 1' or 'Type 2', and were treating them according to their needs, not their label. Fast forward ten years, I went to a talk last year by the head of the Diabetes unit, who referred to 'Type 1' and 'Type 2' all the way through his talk!

 

[mikeyB]

That’s the sensible way to do it. Dividing things up (3c is my bete noir) doesn’t help, when the difference with type 1 is the manner of destruction of the beta cells. It certainly keeps the pen pushers at NICE content, and the general public.