Five categories. Thoughts? Agree or disagree?

5 types, Not 2

One study is not enough for me to decide if I agree or not. They also don’t give any detail on the court or methodology of the study. The “research” link doesn’t open for me.

Not to mention they neglected another form of diabetes classification there is already: diabetes insipidus.

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But the current system of classification is flawed. Many people get mistakingly diagnosed all the time. It’s a start on having a discussion that may help refine treatment strategies in the future.

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It is just my opinion, but I see a lot of people misdiagnosed every day, because their providers don’t understand the difference between the current classifications. I’ve seen few endocrinologists misdiagnose.

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I think the article and study are pretty clearly discussing diabetes mellitus only. Diabetes insipitus is a completely different condition that has nothing to do with blood sugar.

I like the idea of more categories if it leads to better treatment. But there is already a lot of confusion around Type 1 and Type 2, so that may increase if there were five or six types.

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Guess I should clarify. I see patients who come saying “my blood glucose is running 267 every day” yet won’t increase their dose because their GP says “your dose is fine, and testing once a day/week/month is enough.” I blame the docs for being ignorant.

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Therin lies the problem. You are educated in your condition, but most aren’t. Even you just classified mellitus and insipidus into two categories. You know the difference, most (including doctors) don’t. The article talks about “diabetes” - this blurring the lines of general knowledge more.

Educating one’s self is important. No doctor will care more than the patient cares.


Wow. If a doctor doesn’t know the difference between diabetes insipidus and diabetes mellitus, two conditions that are utterly different in cause and treatment, they shouldn’t be treating either type of diabetes. And maybe shouldn’t be doctors…

In my (non-medical-background) experience, everyone referring to just “diabetes” is referring to diabetes mellitus. The only people who seem to know about diabetes insipidus are (presumably) doctors and people who have it. And people like me who somehow learned about this fact at some point.


I agree. To many people trust their GP to be an expert in everything, and they can’t be. They should refer people to specialists.

Yep. Yet there are two classifications before you classify mellitus further.

One of the problems is the symptoms of mellitus and insipidus are quite similar. My own Endo told me for 1.5 years “your blood sugars must be running high” (tho they weren’t) and she was am exceptional Endo.


Here’s another shot at the research @kmichel - it opened fine for me. And the research is more compelling than the article. It sounded to me that @ClaudnDaye was interested in sharing that research, and I’m sure he’s not keeping a record of whether or not we all agree so he can tease us about it down the road. :wink: :memo:

Also, it was clear to me as I read the abstract that the research was tailored to endocrinologists and their patients, trying to group diabetic patients into groups with various outcomes.

It would seem that helping patients to have a specific course of action, based on the probabal outcomes of their subtype would be a good thing.

It is unfortunate that so many people are misdiagnosed and that they receive poor care or bad instructions on how to best deal with their disease. I agree that referrals are an important part of the healthcare process. However often here there’s an discussion about whether or not endos are even necessary!


Yep it was just an interesting article and I thought I’d share to gain perspectives, insights, and to learn and grow. I just know people get diagnosis wrong all the time so everyone, medical professionals included, could stand to really dissect and understand the differences so that they can better diagnose and treat (the first time around)

Thank you. That link opened for me. Still doesn’t change my opinion.

The same topic was addressed in another FUD thread, and @jag1 provided a clear interpretation. This work was not about “5 types not 2”, it was looking into categorizing adult-onset diabetes only (which is imo long overdue):


First off, while this is one study, it was replicated by three independent research groups with three separate large samples, so it’s quite robust methodology. The researchers are very clear in the actual Lancet paper that they are looking primarily at adult-onset diabetes with intent to differentiate between forms of T2. These researchers used a common methodology called cluster analysis, which is a data-driven (vs hypothesis-driven, so a prior ideas are not imposed on the data but rather group structure arises out of the data itself) statistical approach that determines the number of groups that best characterize the data so that participants each fit well within a single cluster. I’ve used this type of analysis in my own research. In their analysis, they used the following variables to determine clusters: glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance. As best I can tell from my brief skim of the article, because GAD antibodies are a binary variable, that inevitably led to all those people in a separate cluster, so the more nuanced part of the analyses really was about sorting the non-GAD positive/T2 folks out. Those groups were replicable across samples. What this really should be taken primarily as is a more sophisticated form of descriptive data (rather than necessarily indicating anything regarding underlying pathology; that’s beyond the scope here), in that these groups seem to consistently emerge among T2 diabetes across several samples, and the clinical importance of that is that there seems to be different group outcomes in terms of complications, so it’s useful info suggesting doctors need to not just label someone as T2 and wash their hands of it. At particular risk for some complications was the cluster that was GAD negative but had otherwise similar characteristics to the T1 cluster, probably because they are being (inappropriately) treated like other less severe forms of T2.

If anyone wants the PDF of the actual research article (which IMO is the only way to evaluate the research), let me know, and I can send it along.


Thank you for breaking that down @cardamom. I really appreciate it. Good point about reading the actual research before making a decision about it. Makes more sense now. I just had a ridiculous GP-with-a-speciality-in-diabetes run in today, in regards to my mom who’s got T2, and I certainly wish some doctor were educated about these various risk factors (or even any possible complications at all would be been nice.)

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