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Subtypes of Type 2 Diabetes by Clinical Parameters

Subtypes of Type 2 Diabetes by Clinical Parameters

Type 2 diabetes (T2DM) is increasingly recognised as a highly heterogeneous disease, with individuals with varying clinical characteristics, disease progression, drug response, and risk of complications.

In contrast to the traditional models for sub-classification of T2DM, the authors used clinical parameters to cluster a cohort of Swedish patients with diabetes into several subtypes. These subtypes have been robustly reproduced in several populations and are associated with different risks of complications, comorbidities, genetics, and response to treatment, providing a framework for personalised medicine in diabetes.

The authors classification method is based on six clinical parameters: glutamate decarboxylase autoantibodies (GADA), age at diabetes onset, HbA1c, body mass index (BMI), and measures of insulin resistance and insulin secretion, resulting in five subgroups with different risk of complications (1 subgroup associated to autoimmune diabetes and 4 subgroups traditionally associated with T2DM):

  • severe autoimmune diabetes (SAID) group, defined by presence of GADA, includes antibodypositive individuals traditionally referred to as type 1 diabetes and latent autoimmune diabetes of the adult (LADA), and was characterized by early disease onset, low insulin secretion, relatively low BMI, and poor metabolic control;
  • severe insulin-deficient diabetes (SIDD) group had low insulin secretion, poor metabolic control, negative autoantibodies and increased risk of retinopathy and neuropathy;
  • severe insulin-resistant diabetes (SIRD) group was associated to obesity and high insulin resistance and had the highest risk for diabetic kidney disease and fatty liver;
  • mild obesity-related diabetes (MORD) group was marked by clinical obesity and early onset;
  • mild age-related diabetes (MARD) group had late disease onset and an overall low risk of complications.

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Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
,
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
,
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Publication under Spotlight

Subtypes of Type 2 Diabetes Determined From Clinical Parameters

Diabetes
2020;69(10):2086-2093.

Authors: Emma Ahlqvist, Rashmi B. Prasad and Leif Groop

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