DR. MITCH: Diabetes: 2 Types Aren't Enough?

There is a trend now in medicine to personalize our management of disease. In other words, to understand the illness better but also the specific genetic makeup and medical background of our patients so that the treatment more accurately reflects the nuances that make each of us unique. A recently reported new way of looking at diabetes fits in with that trend.

Diabetes happens when the sugar that's in the blood stream can't get into the individual cells of our body where it is used as fuel to keep the cells going. Insulin is the key to unlock the door into the cells. It's made by the pancreas, an organ that sits deep within the belly.

In type 1 diabetes, the body's own immune system attacks and destroys the cells that make insulin in the pancreas so that there is no more. Typically these are young patients who lose weight in spite of a voracious appetite, are constantly thirsty and urinating very frequently.

Type 2 diabetes is different. This is usually found in older and overweight people and there we have a pancreas which is able to make insulin but the body's demands exceed the organ's ability to deliver. In the past we thought of all type 2 diabetics as the same: too much fat, relatively too little insulin.

Researchers in Scandinavia recently reported in: The Lancet: Diabetes and Endocrinology, on their work looking at diabetics. They were able to classify 4 subcategories of type 2 diabetes which were different based on relatively straightforward lab tests and other basic data like age and weight. Different because they were more or less serious; required different levels of care; and, were associated with different risks of complications.

This information is important. It means that not all type 2 diabetics are the same. Instinctively many family docs and those specializing in diabetes management knew this, now they have a strong scientific justification for managing this patients in a more personalized way which will mean better care.