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Medicine Science

Diabetes Is Actually Five Separate Diseases, Research Suggests (bbc.com) 114

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

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Diabetes Is Actually Five Separate Diseases, Research Suggests

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  • by pollarda ( 632730 ) on Sunday March 04, 2018 @02:17PM (#56206251)
    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... [nih.gov]
  • 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.
    • And you are an expert on this because...
      • Re: (Score:2, Funny)

        by Ries ( 765608 )

        And you are an expert on this because...

        Certified internet WebMD doctor here, can vouch for demonlapin.

      • Have you actually done any reading on this, or dealt with the problem yourself? It's pretty straight forward.

        MANY people with 'diabetes' or 'pre-diabetes' can cure it without pills, you just reduce weight, significantly reduce sugar / carbs, preferably exercise.

        Done.

        • I've lived with it for sixteen years. How much experience do you have?
          • by rtb61 ( 674572 )

            I agree with the diet plan. My experience dropped over 1 whole number on the sugar measure since my first diagnosis, from a test, rather then from symptoms and no time spent with doctors relating to it, since the first diagnosis, to another test years later. Just adjusted diet and exercise. I still put one teaspoon of raw sugar in my tea and coffee and that is pretty much it for sugary stuff and I did swap to wholemeal bread and diluted diet drinks (the flavour became way too strong over time, hence half to

        • "Just lose weight" has a 95% failure rate as a treatment. It is so bad the FDA would have rejected it.

          • No, keeping weight off, is a 95% failure rate.

            The weight loss itself very much helps with diabetes, in fact, even if you don't keep it off, assuming the dietary changes are kept (you're just over eating "healthier" food) you're still very likely to be in much better shape.

            Concentrated calories like carbs / sugar, are the devil

            • "Concentrated calories like carbs / sugar, are the devil"

              How are carbs concentrated calories?? Butter has twice the calories per gram as refined sugar.

          • by Anonymous Coward

            "Just lose weight" has a 95% failure rate as a treatment. It is so bad the FDA would have rejected it.

            The Food and Drug Administration often questions any treatment that doesn't generate massive profits.

            Don't pretend for a fucking second they're not biased. They know which side their bread is buttered on. Artificially propping up a multi-billion dollar diabetes industry by only recognizing solutions that come from a prescription bottle is exactly what has been established.

          • But to be fair "just lost weight" can be tried multiple times and many anecdotal evidence suggest that there are millions of people who managed to lose weight and improve health that didn't succeed the first time.

            There is almost no down side to an overweight person to lose weight, unlike most medicines whose have a % of people with side eddect.

            Also, it (should) cost almost nothing, and can be safely used in conjunction with other inteventions, which unlike medicines, would most likely have no negative c

      • Not a diabetologist, but I am an MD practicing in an environment where probably half the inpatients are frankly diabetic. So, while this isn't truly expert opinion, I'm not exactly a babe in the woods.
    • Communist! Processed food industry employs many thousands of people and produces many billion dollars of profit for my portfolio. You want to destroy it all? Conditions that require life long treatment of costly medicines are the cornerstone of our pharma industry. Dont kill the golden goose man!
    • except in cases of type 1 and clusters 1 and 2 in the article summary.....but yeah....

      • My grandmother has type 1 diabetes and manages it primarily with diet and exercise.
        It's worked quite well for her for over 50 years. She's in her 80's now is going strong.

        • Which leads me to suspect that her case could be cluster 2 - too little insulin but there's a little and that's enough for her to cope with it that way.

          Without a thorough check it's hard to tell though.

          But one big problem many of us have is all that hidden sugar in a lot of products that has been added for taste purposes. Even sweeteners is a problem. The type of sugar may also be a factor.

      • "except in cases of type 1 and clusters 1 and 2 in the article summary.....but yeah.."

        I was going to say much the same thing. Even for Type 1, Carbohydrate management is probably advisable as it should make guessing proper insulin dosage a lot easier. The consequences of getting the dosage wrong can be serious or even fatal. And the $#@% blood glucose test strips don't seem to work anywhere near as well in practice as experimental results say they should.

      • Those would be the ones that would require supplemental insulin regardless. Doesn't mean you shouldn't cut way back on the carbs.
    • all forms of diabetes are amenable to at least partial treatment with one simple mechanism: stop eating sugar and and easily-digested starches

      I know that reading the whole article might be too much for you but reading the summary seems to be as well. The summary says this:

      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

      • He could just be American, where we insist on our right to express outrage at a story after only reading the headline.

      • You could just read my second sentence, you know. Cluster 1 will always need some insulin, but can cut their needs substantially. Cluster 2 might not, if they can get their insulin demand below the level that their pancreas can supply. And that's primarily determined by diet.
        • You could just read my second sentence, you know. Cluster 1 will always need some insulin, but can cut their needs substantially. Cluster 2 might not, if they can get their insulin demand below the level that their pancreas can supply. And that's primarily determined by diet.

          This is what you wrote:

          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.

          So let me rephrase your wording so you understand how silly you sound:

          Curiously enough, all forms of cancer are amenable to at least partial treatment with one simple mechanism: stop eating sugar and and easily-digested starches. Some will require supplemental chemotherapy, of course, but that small step will work wonders even for them.

          Also let me edit your words to be accurate:

          Cluster 1 will always need some^H^H^H^H insulin for the rest of their lives regardless of diet. Cluster 2

    • 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.

      Umm, no. Some of us have diabetes because our pancreas is sitting in a jar of formaldehyde on a surgeon's desk....

      • by slazzy ( 864185 )
        That's so very not true at all. For type 1 diabetes, the body produces zero insulin - a hormone required to live, without it you die. It is not caused by eating sugar, it's caused the same way as 250+ other autoimmune disorders such as rheumatoid arthritis your body attacking itself - the reason for which medical science still doesn't know why.
      • Try the second sentence. It's not that much farther along in the comment.
    • I'm afraid it's not a good classification system, for exactly the reason you've described. I've done some investigation lately, due to colleagues who handle their diabetes or who've family with diabetes. And since I've become older, it's more common among my older peers, and I've gotten to know a few children with diabetes in my lifetime.

      I've found it helpful to segregate by pathology, such as "juvenile onset" which described the auto-immune problem that destroys insulin producing cells. I was also informed

    • The far more common form of diabetes, aka Type 2 diabetes, is tied to insulin resistance. This makes it more difficult to exercise, since normal use of glucose is impeded, and the resulting raised insulin level also raises hunger. Between the lethargy, and the hunger, it' can be difficult to avoid weight gain. The weight gain reduces the effect of available insulin several distinct ways. This creates positive feedback. It also lets people blame the victim, thinking that the weight gain is the cause of the d

      • You won't hear any argument from me on that, except that I would say that exercise is only a small part of weight control.
  • 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, re
  • Where does gestational diabetes fit into all this?
  • 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

    • So you had a shitty doctor and in your view that makes the entire profession bad?

    • by ghoul ( 157158 )

      Same here. Got acute attack of pancreatitis and then got diagnosed as diabetic. Never ate sugar even in coffee as both parents had adult onset. Doctor keeps prescribing meds but nothing works except insulin. I have a weight of 170 pounds on a 5 7 frame so not morbidly obese but the general advice is lose weight. Hell I am taking Insulin 50 units a day and insulin makes you fat. How are you supposed to lose weight when you are barely 10 pounds above normal for the height and the insulin injections you take m

    • Insulin is made in the pancreas. After pancreatitis or pancreatectomy (such as for trauma or cancer), you no longer have the islets of Langerhans in which the insulin is made. No insulin, thus you have diabetes. Type 1 and Type 2 (and this new nomenclature) refer to endogenous disorders for which some disease, understood or otherwise, is at work. Post-pancreatic diabetes is not related to the endogenous Types. Its pathogenesis, diagnosis, and treatment are all clear cut. Your insulin making machine ha

    • 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.

      Can we choose which one we self-identify as having?

  • 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, bu

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