Toward A More Accurate Classification Scheme

Summary of a scandinavian study that proposes a more detailed and accurate system of classification.

http://www.endocrinologyadvisor.com/diabetes/fine-tuning-diabetes-classification/article/507450/

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So, one classification for Type 1? Why donā€™t they just call it juvenile diabetes again and make us ALL happy?

Well, mostly because it doesnā€™t only strike juveniles, I suspect.

Iā€™m just glad to see what they call ā€œCluster 2ā€ recognized as a real grouping. Iā€™ve been trying for years to make people believe there is such a thing, with little success.

I think there are lessons to be drawn from ā€œbig data.ā€ From the study summary:

ā€œActually, the findings made a lot of sense when we got the first result and we were very happy to achieve them using a data-driven approach,ā€ said Dr Storm. ā€œTaken together, the study enables the development of a road map for the diabetes patient, paving the way for early intensified treatment and thereby a way to possibly prevent late diabetic complications ascribed to the ā€˜metabolic memory.ā€™ It may also help the pharmaceutical industry to better stratify patients for drug trials and thereby reduce costs for development of new drugs.ā€

Anything that can get the right treatment to the correct patient in a timely manner will be good for us. It seems ambitious; I hope itā€™s doable. Changing the way of thinking of a large group of people is a daunting challenge.

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My point is, the development and progression of Type 1 in adults is not the same as children. When it confuses doctors and patients (and the general public), then there needs to be a delineation. Treatment is not the same at the beginning and changes slower than the kiddies.

I have said this before: More granular classification can lead to better care and, perhaps, better insurance coverage (in the US, at least). The current system clearly hasnā€™t been effective enough - with people being misdiagnosed one way or the other - sometimes with terrible consequences. Type 1 clearly needs to be identified without unambiguously as soon as possible to result in less risk and better outcomes. Type 2. on the other hand is simply too diverse to be treated as one category: some need only lifestyle changes, some insulin, and some need one or more meds in order to achieve and maintain control. The many variations promote all the misinformation and misunderstanding we see today. In an age when other diseases and conditions are being defined with great specificity, it is ludicrous that Type 2 Diabetes is still a giant ā€œcatch-allā€ for non-Type-1 glucose dis-regulation.

I agree @Terry4 about the role of ā€œbig data.ā€ When I got my Masters in Healthcare Informatics, one of the goals we discussed was the aggregation of data among healthcare providers and across regions. I got excited about the information that could eventually be mined from all the health data that has been and is being collected. This appears to be a sample of what can be learned from this resource ā€“ and itā€™s not even close to a fully realized objective.

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I agree that the treatment and emotional factors for people diagnosed when they actually are ā€œjuvenilesā€ are very different to what adults experience. On the other hand, itā€™s not all the same for adults either. My progression from zero to DX at age 28 was more like the ā€œjuvenileā€ model than the process many other adult T1s describeā€“there seem to be a couple of distinct patterns.

On the other other hand, the T1/T2 terminology wasnā€™t in widespread use back then so I actually was dxā€™d with ā€œJuvenile Type.ā€

I developed T1 at the age of 21. Definitely an adult. I was not LADA; I had all the classic symptoms and would have probably been dead in a week or two if I hadnā€™t been diagnosed when I was. Thereā€™s a lot of variability. Iā€™m guessing my BG was between 800 to 1000; I didnā€™t know then to ask them. And since many, many medical pros still seem to believe an adult canā€™t develop T1, I say we jettison the word Juvenile for good.

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My Doctor said you have diabetes and this is what we are going to do about it. And having done the research the consequences are the same. The treatment varies.