Not all prediabetes are the same. People in the early stages of type 2 diabetes have six distinct subtypes with different onset of disease, risk of diabetes, and onset of secondary disease. This has been shown in studies by the University of Tubingen, the University of Tubingen Hospital, and the Institute for Diabetes Research and Metabolism (IDM) at Helmholtz Zentrum München at the German Center for Diabetes Research (DZD). The result is now Nature medicine.. The new classification will help prevent the development of diabetes and diabetic complications through targeted prevention in the future.
Diabetes is a global epidemic. Since 1980, the number of diabetics has quadrupled worldwide. In Germany alone, 7 million people are suffering. And that trend is still growing. By 2040, the number of people with type 2 diabetes could grow to 12 million. However, type 2 diabetes does not develop from one day to the next. People often experience a longer preliminary stage of diabetes. Blood sugar levels are already rising there, but people are not yet ill. “For people with pre-diabetes, predict whether they are at risk of developing diabetes and serious complications such as renal failure, or if they have only a harmless form with slightly higher blood sugar levels but no significant risk. It has never been possible to do that. ” Professor Hans Ulrich Herring, who started his research 25 years ago, said. However, such a distinction is important for targeted prevention of metabolic diseases and therefore for combating the diabetic pandemic. Tubingen researchers have now achieved an important breakthrough. Using cluster analysis * of pre-diabetic patients, we found six different subtypes with different risks of diabetes. The differentiated classification of pre-diabetes and diabetes makes it possible to carry out individualized early prevention and treatment of diabetes and its secondary diseases in a manner adapted to the development of diabetes and its secondary diseases.
Prediabetes: 6 different clusters identified
A research group led by Professors Häring and Fritsche at the University Hospital in Tübingen conducted a detailed study of the metabolism of pre-diabetic patients who are still considered healthy. Subject (n = 899) comes from the Tubingen Family Study and the Tubingen Lifestyle Program Study. They have undergone repeated intensive laboratory tests, laboratory chemistry, magnetic resonance imaging, and genetic testing in Tübingen for the past 25 years. Based on key metabolic parameters such as blood glucose, liver fat, body fat distribution, blood lipid levels, and genetic risk, researchers were able to identify six subtypes of prediabetes. “Like obvious diabetes, there are many different types of disease in the early stages of diabetes, with different blood sugar levels, insulin action and insulin secretion, body fat distribution, hepatic fat, and genetic risk,” said the lead author. Professor Robert Wagner said. Helmholtz Zentrum München’s DZD Diabetes Research and Metabolic Disease Institute (IDM) at the University of Tübingen, summarizing the results of the study.
Three of these groups (clusters 1, 2, and 4) are characterized by a low risk of diabetes. Study participants in clusters 1 and 2 were healthy. Slim people are a key member of Cluster 2. They have a particularly low risk of developing complications. Cluster 4 is made up of overweight people, whose metabolism is still relatively healthy. The remaining three subtypes (clusters 3, 5, and 6) are associated with an increased risk of diabetes and / or secondary disease. People who belong to subtype 3 produce too little insulin and are at increased risk of developing diabetes. People in cluster 5 have a marked fatty liver and a very high risk of diabetes because their body is resistant to the hypoglycemic effects of insulin. Subtype 6 causes kidney damage even before the diagnosis of diabetes. Mortality is also particularly high here.
But can the classification into the six prediabetes subtypes be confirmed in other cohorts? To investigate this, researchers extended the analysis to include nearly 7,000 subjects in the Whitehall II cohort in London, where they also identified six prediabetes subtypes.
More targeted precautions
Researchers are already planning further. “Next, prospective studies first try to determine how applicable new discoveries are to classify individuals into risk groups,” said Professor Andreas Fritzsche of the University of Tubingen Hospital. In this case, people with a high risk profile can be identified early and receive specific treatment.
Materials provided by Deutsches Zentrum fuer Diabetesforschung DZD.. Note: The content can be edited in style and length.