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Study suggests diabetes may be five separate diseases

Study suggests diabetes may be five separate diseases

Publication date: Monday, 19 March 2018
Contributor(s): Jeremy Bray

A fascinating new study from Sweden and Finland suggests that diabetes is actually five separate diseases and treatment could be tailored for each type. Study authors suggest these findings will usher in a new era of personalised medicine for diabetes.

The study assessed 14,775 patients with newly diagnosed diabetes from a number of Scandinavian registries and included a detailed blood analysis measuring glutamate decarboxylase antibodies, together with noting age at diagnosis, BMI, HbA1c, and homoeostatic model assessment estimates of β-cell function and insulin resistance.

The results showed that patients could be separated into five distinct clusters which had significantly different patient characteristics and risk of diabetic complications (Table). In particular, individuals in cluster 3 (most resistant to insulin) had significantly higher risk of diabetic kidney disease than individuals in clusters 4 and 5, but had been prescribed similar diabetes treatment. Cluster 2 (insulin deficient) had the highest risk of retinopathy. In support of the clustering, genetic associations in the clusters differed from those seen in traditional type 2 diabetes.

Study author Professor Leif Groop said, "This is extremely important, we're taking a real step towards precision medicine. In the ideal scenario, this is applied at diagnosis and we target treatment better."

Dr Victoria Salem, a consultant and clinical scientist at Imperial College London, who was not involved in the study, said: "This is definitely the future of how we think about diabetes as a disease". Whilst the proposed classification presents some advantages, more research would be needed to test whether it would be robust enough to use in clinical practice.


  • Cluster 1: Severe autoimmune diabetes similar to classical type 1 – early onset of an immune disease leaving patients unable to produce insulin
  • Cluster 2: Severe insulin-deficient diabetes – patients initially looked similar to cluster 1 - but a defect in beta-cells is the likely cause rather than the immune system
  • Cluster 3: Severe insulin-resistant diabetes – patients generally overweight and making insulin but their body was no longer responding to it
  • Cluster 4: Mild obesity-related diabetes –  seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
  • Cluster 5: Mild age-related diabetes – patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder



This study is a first step in identifying sub-groups within diabetes. This study is only in Scandinavians and suggests five clusters; further studies in other groups including South Asians may well uncover many other groups. The study will not change diabetes practice but opens the door to new area of research with the aim of personalising diabetes treatment. 

Ahlqvist E, Storm P, Karajamaki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes and Endocrinology 2018; DOI:

Topics covered:
Category: Evidence in Practice
Edition: Volume 3 Number 3 PCCJ Online 2018
Contributor(s): Jeremy Bray

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