Research finds six types of pre-diabetes

German scientists have, for the first time, identified six different types of pre-diabetes.

Pre-diabetes is a condition that precedes the onset of type 2 diabetes.

The research, tracking data from a 25 year-long study, suggests the new subtypes of pre-diabetes will help doctors more precisely identify people most a risk of developing type 2 diabetes.

Type 2 diabetes

Type 2 diabetes usually develops quite slowly.

As blood glucose levels rise doctors can diagnose patients with pre-diabetes, when their levels are consistently higher than normal. But not high enough to be considered type 2 diabetes.

Not everyone with pre-diabetes goes on to develop type 2 diabetes.

For some these increased blood glucose levels can be relatively harmless, with no symptoms, but for others pre-diabetes can be an early sign of serious health issues.

Is pre-diabetes a precursor to type 2 diabetes?

“Until now it has not been possible to predict whether someone with pre-diabetes would develop type 2 diabetes and be at risk of serious complications. Or whether they would only have slightly higher blood glucose levels but without significant risk,” explains Hans-Ulrich Häring, from the University of Tübingen.

About the research

The new research, analyzed 25 years of data from 900 subjects taking part in a longitudinal family health study.

Using cluster analysis the research homed in on six different pre-diabetes subtypes. Each distinguished by different metabolic markers.

“The study showed that there are different disease types in the preliminary stage of diabetes. Each type differs in blood glucose levels, insulin action and insulin secretion, body fat distribution, liver fat and genetic risk,” notes Robert Wagner, author on the new study.

Six types of pre-diabetes

Each of the six pre-diabetes subtypes found in the study is distinguished by specific metabolic parameters and result in different long-term outcomes.

Three subtypes (clusters 1, 2 and 4) are the healthier types of pre-diabetes. These subjects present as generally healthy. Cluster 4, for example, encompasses overweight subjects with broadly healthy metabolic markers.

Clusters 3, 5 and 6 were linked to the highest risk of developing type 2 diabetes and secondary diseases. Cluster 5 grouped those subjects with pronounced fatty liver, while cluster 3 grouped those who produced significantly lower levels of insulin.

To further validate these six subtypes, the researchers examined data from another longitudinal study. Called Whitehall II, the UK study tracked the metabolic health of nearly 10,000 subjects for over 20 years.

They found the six pre-diabetes subtypes accurately fit that large dataset, confirming pre-diabetes can be distinguished into separate disease stratifications.

What this means for future diabetes treatment

Researchers suggest more work is needed before the findings can be used by doctors.

Martin Hrabě de Angelis, from the German Center for Diabetes Research, says this work is important in helping catch and treat diabetes before the condition progresses.

“One of our goals is to develop precise prevention and therapy measures, for individuals at the right time.”

“The combination of in-depth research with state-of-the-art bioinformatics has made this important result possible. The identification of subtypes is an important step towards precision medicine in the prevention of diabetes and its complications.”

The study was published in the journal Nature Medicine.

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