The Diabetes Squad: Meet the Different Types of Diabetes

Table of Content

• Introduction

• Type 1 Diabetes Mellitus (T1DM)

• Type 2 Diabetes Mellitus (T2DM)

• Gestational Diabetes Mellitus (GDM)

• Latent Autoimmune Diabetes in Adults (LADA)

• Monogenic Diabetes

• Secondary Diabetes

Introduction

Diabetes Mellitus (DM), a condition that affects millions worldwide, is not a one-size-fits-all disease. It's a diverse group of disorders with different causes and characteristics. Back when I was still in Med school, I used to live with my relatives who had been diagnosed with Type 2 Diabetes Mellitus and were prescribed insulin therapy. It was apparent to me that this is a complex disorder of the human body, but from my experience watching my relatives live with diabetes, I was pretty certain that the battle is far from over. #EmpoweringGlobalHealth

Over the years, I learnt that there are more to this disorder, at the very least, there are more than 1 or 2 types of diabetes mellitus that exist. Here, I am going to share the various other types of diabetes. Ask yourselves at the end, which one have you been diagnosed with and why?

Think of diabetes as a team of villains in a comic book, each with its unique superpowers. They're part of the same gang, but they're all different. Today, we're going to meet these characters: Type 1, Type 2, Gestational, Monogenic, and Secondary Diabetes.

Type 1 Diabetes Mellitus (T1DM)

Meet the 'Misguided Missile'. This guy is a bit of a loose cannon. The body's immune system, which usually acts like our personal superhero, gets confused and starts attacking the good guys - the insulin-producing cells in our pancreas. This leads to a total lack of insulin. T1DM is often seen in kids and teenagers, but it can show up at any age. The exact cause? Well, it's like a whodunit mystery, with clues pointing towards a mix of genetic and environmental factors.

Type 2 Diabetes Mellitus (T2DM)

Now, here's the 'Sneaky Locksmith'. This one is the most common, making up about 90% of all diabetes cases. In T2DM, the body becomes resistant to insulin with some being lack of insulin in the body. It's like the body's cells change the locks and forget to tell insulin. At first, the body tries to keep up by making more insulin, but over time, it just can't keep up. While T2DM used to be a problem for the over-45 crowd, it's now sneaking up on younger folks due to things like fast food, Netflix marathons, and desk jobs. Its prevalence is rising with increasing degrees of obesity and age.

Gestational Diabetes Mellitus (GDM)

Introducing the 'Pregnancy Prankster'. This one's a temporary visitor that pops up during pregnancy, affecting about 7% of all pregnancies. It usually shows up in the second or third trimester and increases the risk of future T2DM for both mom and baby. GDM can lead to complications like high blood pressure and may require some medical interventions.

Monogenic Diabetes

Say hello to the 'Genetic Jester'. This rare form, making up 1-5% of all cases, is caused by a single genetic mutation. It includes conditions like neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY), which typically shows up before the age of 25. It's like the wild card of the diabetes squad.

The most common mutations are related to genes hepatocyte nuclear factor-1-alpha (HNF1A, MODY3) and glucokinase (GCK, MODY2) genes in 50-60% and 15-30% of people with monogenic diabetes, respectively.

MODY1, hepatocyte nuclear factor-4-alpha (HNF4A)	Reduced insulin secretion in response to glucose in the diet. Patients may initially do well with oral medications (sulfonylureas) but eventually may need insulin, and are at risk for complications of diabetes.
MODY2, glucokinase (GCK)	Troubles converting glucose into a signal for the pancreas to make insulin. Therefore, insulin is not made until higher glucose levels are reached in the blood. Mild, stable, and not associated with complications. Can be controlled with diet.
MODY3, hepatocyte nuclear factor-1-alpha (HNF1A)	Reduced insulin secretion and glucose wasting in the urine. Patients can often be treated with oral medication (sulfonylureas), even if they were previously taking insulin. Patients are at risk for complications of diabetes, including cardiovascular mortality.
MODY4, insulin promoter factor 1 (IPF1)	Reduces the body’s ability to tell insulin to be made. It can be seen in different ways in individuals, from needing insulin to having late-onset type 2-like diabetes to having slightly higher blood glucose levels. Treatment is based on the severity of the individual.
MODY5, hepatocyte nuclear factor-1-beta (HNF1B)	A multitude of problems besides diabetes, i.e small pancreas size, abnormal kidney development, slowly progressive kidney disease, low magnesium levels, elevated liver tests, and genital anomalies.
MODY6, neurogenic differentiation factor 1 (NEUROD1)	Troubles with the development of insulin-producing cells of the pancreas. Requires insulin treatment.

Latent Autoimmune Diabetes in Adults

Agent LADA often starts their secret mission in adults who think, "Ah, it's just Type 2 Diabetes, I got this." But LADA has a trick up its sleeve – it carries special ID badges called autoantibodies, which are like secret handshakes that show they're part of the autoimmune gang. These badges can be GAD or ICA – fancy codes for the tools LADA uses to sneak around the pancreas. Here's the catch: Agent LADA is a slow mover. It doesn't rush to action like Type 1 Diabetes, which tends to go all out from the get-go. Instead, LADA takes its time, sometimes years, before it requires the insulin arsenal. This slow burn mission can confuse doctors and patients alike, as LADA can initially seem to respond to pills meant for Type 2 Diabetes, only to later call in for insulin backup.

Secondary Diabetes

Last but not least, meet the 'Sidekick'. This type is a side effect of other diseases or medications. For example, conditions messing with the pancreas or hormonal disturbances can lead to secondary diabetes. Certain drugs, like corticosteroids, can also trigger it.

So, there you have it - the Diabetes Squad! Understanding these characters is the first step in managing this condition. Remember, knowledge is your superpower, and you're already on your way to becoming a diabetes superhero!

References:

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• Maruyama T, Nakagawa T, Kasuga A, Murata M. Heterogeneity among patients with latent autoimmune diabetes in adults. Diabetes Metab Res Rev 2011; 27:971.

• Tuomi T, Groop LC, Zimmet PZ, et al. Antibodies to glutamic acid decarboxylase reveal latent autoimmune diabetes mellitus in adults with a non-insulin-dependent onset of disease. Diabetes 1993; 42:359.

• Leslie RD, Williams R, Pozzilli P. Clinical review: Type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab 2006; 91:1654.

• Naik RG, Brooks-Worrell BM, Palmer JP. Latent autoimmune diabetes in adults. J Clin Endocrinol Metab 2009; 94:4635.

• ElSayed NA, Aleppo G, Aroda VR, et al. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S19.

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