October 14, 2013

Sub-Classes for Type 1 and Type 2

This study heightens the need for sub-classes not only for type 2, but also for type 1. When I first blogged about sub-classes for type 2 diabetes back on August 5, I expected to have a lot of dissension, but received none. Now I am seeing others promoting this possibility, but no one is actually saying classes, but phenotypes of diabetes mellitus in relation to their immunological, metabolic and genetic profiles. I admit I like the term sub-classes, but I will work with a technical definition.

The DiMelli (Diabetes Mellitus Incidence Cohort Registry) study examines the frequency and characteristics of diabetes phenotypes in children and young adults below the age of 20. The study was commissioned to investigate the increasing incidence of diabetes mellitus, particularly in childhood and early adulthood. The project is funded by the German Center for Diabetes Research (DZD). Bioprobe measurements were performed centrally by the Central Medical Laboratory (LMZ) at the Helmholtz Zentrum München (HMGU) so as to guarantee the high quality and comparability of laboratory parameters. The study is based on the DiMelli Bavarian Diabetes Register, the only register of its kind in Germany, which collects data on biological parameters in the blood of newly diagnosed diabetics as well as their phenotypic characteristics, i.e. their physical symptoms and features.”

I quoted the above to give some background that we are talking about children and young adults. Yes, I do think this type of study needs to be undertaken for all ages. This could be a boon to driving research in the right direction for the different age groups. A blog published on September 24 covers some of the findings for the elderly and shows at least two sub-classes.

The one idea from the discussion that really drove the above home for me is that the youth are generally type 1, and yet there are increasingly more type 2, and possibly some that are type LADA. With the growing number of youth developing diabetes, this is an area needing more study.

The authors conclude that the latest scientific findings no longer support such a rigid classification of diabetes. Rather there appears to be a continuum of forms and a mixture of diabetes phenotypes. In order to be able to introduce the right steps in treatment and to offer patients accurate information about their disease, it is essential to refine the criteria for differentiating and diagnosing the different forms of diabetes. Further studies are now needed to shed light on the long-term development of the phenotypes, the distribution of different types of diabetes, and the way in which their features present themselves in adult patients. This is required to provide more clinical evidence for physicians to use.

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