New research identifies six subtypes of diabetes and could help treat at-risk individuals

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  • Individuals diagnosed with prediabetes have higher blood glucose levels and have the potential to develop type two diabetes
  • A new study has identified six subtypes of diabetes based on different risk factors and potential complications
  • These subtypes could help doctors better detect individuals at risk for diabetes and develop treatments tailored to the individual’s cluster and needs


The development of type two diabetes is often a slow process and leads to a phase of prediabetes which can be left undiagnosed. Determining prediabetic sub-phenotypes could improve the detection of at-risk individuals and subsequent diabetic complications.

Health24 previously reported that prediabetes occurs when an individual’s glucose levels are higher than normal, but not high enough to warrant a diabetes diagnosis.

An international 25-year study published in Nature Medicine set out to identify and categorise six subtypes of diabetes based on oral glucose tolerance test (OGTT) variables and diabetes pathogenesis models.

The researchers analysed 899 at-risk individuals and categorised the six subtypes (referred to as clusters) through shared biomarkers. This included body fat distribution, liver fat content, genetic risk and glucose levels, the study explains.

What are the different clusters?

This method, according to the researchers, allowed the clusters to be differentiated based on the individual’s risk for developing type two diabetes and the potential complications thereof.

Clusters one, two and four consist of individuals who are either not overweight or are overweight but have a healthy metabolism. These individuals are at a lower risk for developing diabetes, according to the researchers.

Individuals in clusters three, five and six are linked to an increased risk of diabetes and developing complications, the study states.

This is because individuals in cluster three do not produce enough insulin and show biomarkers for higher intima-media thickness (IMT) in their arteries, explain the researchers.

Additionally, individuals in cluster five are at the highest risk of type two diabetes and are likely to develop renal and vascular disease. According to the study, characteristics of cluster five individuals also include obesity, insulin resistance and higher amounts of liver fat.

Cluster six individuals are insulin resistant and have higher amounts of visceral and renal sinus fat. Although these individuals are at a lower risk for developing diabetes compared to those in clusters three and five, they have a higher mortality risk and are likely to develop chronic kidney disease, the study states.

Better treatment and detection

This method of categorising individuals based on their risk of developing diabetes can help doctors to better identify insulin resistance, mortality and potential prediabetic complications, according to the researchers.

“With further development and validation, such approaches could guide prevention and treatment strategies for cardiovascular and renal disease as well as type two diabetes,” the researchers conclude.

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