Diabetes is five separate diseases
Diabetes is five separate diseases and treatment could be tailored to each form, claim researchers in Sweden and Finland.
Experts said the study was a herald of the future of diabetes care but changes to treatment would not be immediate, reports BBC.
Up to now diabetes has been normally split into type 1 and type 2.
The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.
- Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin
- Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault
- Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it
- Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3
- Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder
The three severe forms could be treated more aggressively than the two milder ones, Prof Leif Groop, one of the researchers, told the BBC.
Cluster 2 had a higher risk of blindness while cluster 3 had the greatest risk of kidney disease, so some clusters may benefit from enhanced screening.
Dr Victoria Salem, a consultant and clinical scientist at Imperial College London, said most specialists knew that type 1 and type 2 was not a terribly accurate classification system.
"This is definitely the future of how we think about diabetes as a disease."