5種新的糖尿病分類

過往的糖尿病粗略的分為1, 2型，在臨床上似乎無法精確分類患者。現在有這5種分類，讓我們照顧起患者，更加了解背後的致病機轉和所應配合的治療方針。

http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr

Scandinavian patients with newly diagnosed diabetes had the following elements collected at baseline: age at diagnosis, BMI, glutamate decarboxylase antibodies (GADA), hemoglobin A1c (HbA1c) levels, and homeostatic model assessment 2 to estimate beta-cell function (HOMA2-B) and insulin resistance (HOMA2-IR) using C-peptide concentrations. Based on these factors, patients were classified into one of the following clusters:

1) Severe autoimmune diabetes (就是過往認為的type 1 DM): affected 6% of patients in the derivation cohort; characteristics include early-onset disease, relatively low BMI, and GADA-positive
2) Severe insulin-deficient diabetes: 18% of patients; GADA-negative but similar to cluster 1; lowest HOMA2-B scores
3) Severe insulin-resistant diabetes: 15%; higher HOMA2-IR scores
4) Mild obesity-related diabetes: 22%; obese, but not insulin resistant
5) Mild age-related diabetes: 39%; older than other clusters, but largely similar to cluster 4

重點是這研究發現：
Patients with severe insulin-deficient diabetes had the highest rates of retinopathy, while those with severe insulin-resistant diabetes had higher rates of end-stage renal disease and coronary events.
作者提醒以上這insulin-deficient和insulin-resistant患者常被當作type 2 DM治療，也許是insulin用得晚。因此，要特別加強這2種分類的患者糖尿病治療，來減少以上的併發症。