A new classification of diabetes

Not everyone who has at some point has high blood sugar, HbA1C levels, or is very overweight will later develop type 2 diabetes. With a new classification in six groups, an attempt is now being made to better assess individual risks.

Three out of the six groups were associated with a significantly increased risk

Not everyone with high blood sugar, HbA1C levels, or significant weight gain will later develop type 2 diabetes. With a new classification in six groups, an attempt is now being made to better assess individual risks.

According to the previous definition, prediabetes is a pathological oral glucose tolerance test (two hour value 140-199 mg / dL), high fasting blood sugar (100-126 mg / dL) or an HbA1C value between 5.7 and 6.4% in the lead. . The annual conversion rate for the onset of type 2 diabetes is 5-10%, and pre-diabetes complications can develop even if the metabolism is pre-diabetes. However, to date, there are no parameters by which an individual prediction can be better predicted.

In order to achieve a better evaluation here, Robert Wagner of the University of Tübingen and his team used the results of the TUEF / TULIP study (Tübingen Family Study / Tübingen Lifestyle Intervention). Since 2003, this study has followed 899 people who have an increased risk of developing diabetes due to abnormal blood sugar levels, a positive family history, an increased body mass index, or a history of gestational diabetes. All participants underwent an oral glucose pregnancy test, specifically based on MRI body fat and proton spectroscopy of lipid content in the liver.

In a cluster analysis, six groups can then be identified, of which three subtypes (3, 5, and 6) are associated with increased risk.

Group 1: low risk:

Although these people are overweight, they have moderate insulin sensitivity and secrete adequate insulin. Glucose tolerance is normal.

Group 2: Very low risk

These people are of a normal weight and have a normal glucose metabolism with good insulin sensitivity.

Group 3: High risk

These people are overweight to obese, with a moderate decrease in insulin sensitivity, an already low insulin secretion and a pre-diabetic metabolic state. There is also an increased genetic risk of developing type 2 diabetes. There is (compared to group 1) a three-fold increased risk of developing type 2 diabetes and a significant increase in the risk of developing cardiovascular disease.

Group 4: Low risk

The patient has obesity (mostly subcutaneous) – with good insulin sensitivity, adequate insulin secretion and normal glucose tolerance. One also speaks of “metabolically healthy obesity.”

Group 5: Very high risk

These patients are not only obese, also liver fat increases dramatically. There is insulin-resistant fatty liver, low insulin secretion and prediabetes. The risk of developing diabetes manifested increases by a factor of 5 and there is a high risk of cardiovascular disease.

Group 6: High risk

These patients also suffer from obesity with a high percentage of visceral fat. Renal halloumi fat increased significantly. There is normal insulin resistance, normal insulin secretion, and normal glucose tolerance. The risk of developing type 2 diabetes is relatively low – but patients are at a high risk of developing diabetic nephropathy even before the onset of type 2 diabetes.

Group classification can be confirmed in 6,810 participants of the British Whitehall 2 group with an observation period of more than 16 years.

Belonging to different groups can have an impact on the choice of preventive measures in the future. In people with subtype 3, endurance exercise and reducing calories to break down visceral adipose tissue may prevent the onset of type 2 diabetes – in subtype 5, an intense diet and lifestyle intervention is indicated. In people with subtype 6, early treatment may be indicated even if blood sugar levels are still normal.

Those:
Wagner, R et al.; Pathophysiology-based phenotyping of individuals at risk of developing type 2 diabetes