Severe insulin-resistant and severe insulin-deficient patients could be targeted for prevention
As published in pharmacy news on 1st August 2019
A new study using five diabetes subgroups suggests patients in different groups face different comorbidities — a finding that could be used to improve prevention and treatment.
Last year, Swedish researchers reported that patients with diabetes could be classified into five subgroups with two broadly overlapping with type 1 diabetes, and the remaining three being more in line with type 2.
The five subgroups were:
Mild age-related diabetes (MARD)
Mild obesity-related diabetes (MOD)
Severe autoimmune diabetes (SAID)
Severe insulin-resistant diabetes (SIRD)
Severe insulin-deficient diabetes (SIDD)
Now German researchers have found that, five years after diagnosis, patients in the SIRD and SIDD subgroups are more prone to two diabetic comorbidities than those in the other three subgroups.
About 11% of the 1105 patients in the study were classified as having SIRD at baseline, the researchers reported in the Lancet Diabetes and Endocrinology.
These patients were more prone to kidney disease and non-alcoholic fatty liver disease than those in the other groups — both at baseline and five years after diagnosis.
They had the lowest mean estimated glomerular filtration rate (eGFR) at baseline (78mL/min per 1.73m2) which was significantly below all the other groups (range 88-105mL/min per 1.73m2).
The finding suggested that insulin resistance might be more important than hyperglycaemia in the development of nephropathy, they said.
SIRD patients also had the highest fatty liver index values both at baseline (88) and five years later (91). In contrast, other subgroup fatty liver index values varied between 45 and 83 at five years.
“Patients with SIRD are truly insulin-resistant and increased C-peptide … is not merely a result of reduced C-peptide clearance in patients with impaired kidney function. Our findings further show that fasting adipose-tissue insulin sensitivity is also lowest in patients with SIRD, indicative of whole-body insulin resistance under both fasting and insulin-stimulated conditions,” the researchers said.
Meanwhile, SIDD patients had the highest rates of confirmed diabetic sensorimotor polyneuropathy — with 36% of the 28 patients classified as being in this group affected by the complication. In contrast, only between 5% and 17% of patients in the other groups had polyneuropathy at baseline.
Five years later, the rate of diabetic sensorimotor polyneuropathy appeared to have increased, with 50% — three of the six SIDD patients measured — confirmed to have the complication.
Insulin deficiency or hyperglycaemia appeared to be an important trigger of diabetic neuropathy, the researchers said.
Patients in the SIRD and SIDD groups should be targeted for prevention of non-alcoholic fatty liver disease and diabetic polyneuropathy respectively, the authors concluded.