Are there 5 types, or clusters, of diabetes?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

A study by Ahlqvist et al suggested that type 1 and type 2 diabetes mellitus can actually be divided into five separate types, or clusters, of diabetes. Using six variables to analyze almost 15,000 patients in Sweden and Finland, the investigators came up with the following clusters, the first of which corresponds to type 1 diabetes and the rest of which are subtypes of type 2 diabetes [35, 36] :

  • Severe autoimmune diabetes (SAID) - Essentially corresponding with type 1 diabetes and latent autoimmune diabetes in adults (LADA), this form is characterized by onset at a young age and patients with a relatively low body mass index (BMI), poor metabolic control, and impaired insulin production; in addition, this cluster is positive for glutamic acid decarboxylase antibodies (GADA)
  • Severe insulin-deficient diabetes (SIDD) - This cluster is similar to SAID but is GADA-negative and is characterized by high HbA1c and the greatest risk for diabetic retinopathy among all the clusters
  • Severe insulin-resistant diabetes (SIRD) - This cluster is characterized by insulin resistance and patients with a high BMI and the greatest risk for diabetic nephropathy
  • Mild obesity-related diabetes (MOD) - Patients in this cluster are younger, have obesity, and are not insulin resistant
  • Mild age-related diabetes (MARD) - Patients in this cluster are older, and their metabolic alterations are modest

The investigators maintained that studies in less homogeneous populations are needed to confirm their results but see their report as a “first step towards a more precise, clinically useful stratification” of diabetes. [36]


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