Classifying diabetes mellitus into subtypes can be the basis for the tailored management of those affected consistent with “precision diabetology.” The goal for the future is early detection of diabetes-related secondary diseases and complications of diabetes. On this basis, the German Diabetes Center (DDZ) developed a clustering that will be presented for the first time by DDZ speakers at the annual congress of the German Diabetes Association in Berlin.

Diabetes subtyping is based on cluster analysis¹ and its review and expansion as part of multi-center diabetes studies in Germany². These investigations determined the parameters used to identify individual diabetes subtypes: Detection of GAD autoantibodies, age at the time of diagnosis, body mass index (BMI), HbA1c level, fasting glucose plasma (blood sugar), and fasting plasma C-peptide values, and gender play a role.

Five Subtypes
Severe autoimmune diabetes (SAID) essentially corresponds to type 1 diabetes and is characterized by reduced beta cell function, the presence of diabetes-associated antibodies, and low BMI scores. The characteristics of severe insulin-deficient diabetes (SIDD) are similar to SAID but without diabetes-associated antibodies. Subtype 3, severe insulin-resistant diabetes (SIRD), is characterized by pronounced insulin resistance and a high BMI score. The traits of subtype 4, mild obesity-related diabetes (MOD), include obesity accompanied by low insulin resistance. In contrast, in subtype 5, mild age-related diabetes (MARD), a later onset of disease is expected, with a slightly elevated BMI and HbA1c value.

The new subtypes display signs of differing risk profiles during the early stages of the disease. “Knowledge of the respective diabetes subtype can stimulate targeted screening for specific secondary diseases and complications of diabetes,” explains Professor Michael Roden, Professor and Chairman of Internal Medicine, Endocrinology and Metabolic Disorders at Heinrich Heine University Düsseldorf (UKD) and German Diabetes Center Director. “However, being classified with a subtype does not yet constitute an established form of diagnosis and will not lead to a specific treatment recommendation; more studies and data are required before this can become a reality.” stresses Roden. 

A Research Tool to Assist Diabetes Professionals
The newly developed DDZ Diabetes Cluster Tool makes it possible to classify people with diabetes into five diabetes subtypes. The extent to which a person corresponds to each of the five subtypes can be represented graphically; however, this is not intended as a diagnosis or to replace the need for medical advice, diagnosis, and treatment but to provide information for interested parties. “The development of the DDZ Diabetes Cluster Tool is the first step in a planned range of services we would like to offer to provide practical support for precision medicine approaches in the field of diabetology.” explains Professor Robert Wagner, Managing Senior Physician at the UKD Department of Endocrinology and Diabetology and Head of the DDZ Clinical Research Center.

The tool was developed in German by Robert Wagner, Tim Mori, Katsiaryna Prystupa, Klaus Straßburger, Marc Bonn, and Olaf Spörkel and will soon be available worldwide in English.

Click here for the clustering tool: https://diabetescalculator.ddz.de

Sources:
¹ Ahlqvist E, Storm P, Käräjämäki A, Martinell M, Dorkhan M, Carlsson A, … & Groop L. (2018). Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. The Lancet Diabetes & Endocrinology 6(5):361-369.

² Zaharia OP, Strassburger K, Strom A, Bönhof G, Karusheva Y, Antoniou S, … & Roden M. (2019). Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. The Lancet Diabetes & Endocrinology 7(9), 684-694.

The German Diabetes Center (DDZ) serves as the German reference center for diabetes. Its objective is to contribute to the improvement of prevention, early detection, diagnosis and treatment of diabetes mellitus. At the same time, the research center aims at improving the epidemiological data situation in Germany. The DDZ coordinates the multicenter German Diabetes Study and is a point of contact for all players in the health sector. In addition, it prepares scientific information on diabetes mellitus and makes it available to the public. The DDZ is part of the Leibniz Association (Wissenschaftsgemeinschaft Gottfried Wilhelm Leibniz, WGL) and is a partner of the German Center for Diabetes Research (DZD e.V.). www.ddz.de/en 

The German Center for Diabetes Research (DZD) is a national association that brings together experts in the field of diabetes research and combines basic research, translational research, epidemiology and clinical applications. The aim is to develop novel strategies for personalized prevention and treatment of diabetes. Members are Helmholtz Munich – German Research Center for Environmental Health, the German Diabetes Center in Düsseldorf, the German Institute of Human Nutrition in Potsdam-Rehbrücke, the Paul Langerhans Institute Dresden of Helmholtz Munich at the University Medical Center Carl Gustav Carus of the TU Dresden and the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard-Karls-University of Tuebingen together with associated partners at the Universities in Heidelberg, Cologne, Leipzig, Lübeck and Munich. www.dzd-ev.de/en