Diabetes is a more diverse disease than medicine currently acknowledges – and treatments could be improved by splitting the disease into more types, according to a new study.

The two “types” of the disease are not precise enough – and the adult-onset varieties of the disease should be split into five distinct categories, according to the paper in The Lancet Diabetes and Endocrinology.

Nearly 15,000 patients in Sweden and Finland were monitored for a variety of factors, including age at diagnosis, body-mass index, long-term glycemic control, functioning of insulin production in the pancreas, insulin resistance, the detection of auto-antibodies, genetic analyses, disease progression, complications, and treatment success.

Some 9,000 of the patients were grouped into categories, which were then tested on roughly 6,000 of the remaining diabetes cases.

The five types are:

  • The mild diabetes related to age, which was most common (affecting between 39 and 47 percent of patients).
  • Another mild diabetes form related to obesity (affecting between 18 and 23 percent of the cases).
  • A severe form of the disease with severe insulin resistance, and a higher risk of kidney disease (affecting between 11 and 17 percent of patients).
  • A severe diabetes profile affecting relatively young people with insulin deficiencies and poor metabolic control, but without auto-antibodies (seen in between nine and 20 percent of cases).
  • Another severe autoimmune form of the disease, commonly known as either Type 1 diabetes or latent autoimmune diabetes in adults (the driver in six to 15 percent of cases).

“We stratified patients into five subgroups with differing disease progression and risk of diabetic complications,” the authors write. “This new substratification might eventually help to tailor and target early treatment to patients who would benefit most, thereby representing a first step towards precision medicine in diabetes.”

The authors contend that treatments are currently not tailored enough to individual patients. With improvement, it could head off complications that can kill, said Leif Groop, lead author, of the Lund University Diabetes Centre in Sweden, and also the Institute for Molecular Medicine Finland.

“More accurately diagnosing diabetes could give us valuable insights into how it will develop over time, allowing us to predict and treat complications before they develop,” said Groop.

There were limitations to the study, however. Notably, the study’s parameters were not able to confirm different causes of the five different types. Also, the patients were all of Scandinavian ancestry – meaning more genetic diversity could show more facets of the disease types.