Diabetes is not a single disease
Most people are bound to know someone who has type 2 diabetes - it's the single most common form of diabetes. The illness is largely hereditary, but fortunately there's a lot we can do to reduce the risk of falling ill.
Type 1 diabetes
Type 1 diabetes principally affects children and adolescents. It is an autoimmune disease, where the body's own immune system attacks the insulin-producing beta cells in the pancreas. Around one in ten patients with diabetes have type 1.
Type 2 diabetes
Type 2 diabetes or adult-onset diabetes is due to reduced release of insulin and impaired uptake in the tissues. It results in raised blood sugar levels and other changes that cause the complications the disease leads to.
Gestational diabetes or diabetes of pregnancy is generally type 2 diabetes, affecting one to three per cent of Swedish women. After delivery, blood sugar levels return to normal, but these women have a greatly increased risk of developing type 2 diabetes later in life.
MODY - Maturity Onset Diabetes of the Young
MODY is similar to type 2 diabetes but affects younger people (usually before the age of 25) who are not overweight. MODY has a specific genetic background, and at least eight forms have been described, each with several different mutations in the gene responsible. In all cases the mutations lead to disturbance of the early development of the beta cells or insulin production. The variant MODY 2 results in significantly milder diabetes, which often does not require drug treatment.
LADA - Latent Autoimmune Diabetes in the Adult
LADA is a form of diabetes first observed around twenty years ago. Despite the fact that LADA accounts for around ten per cent of all cases of diabetes, we need to know far more about the causes of the diseases and how best to treat it.
Five questions for Anneli Björklund, a specialist and researcher at the Department of Molecular Medicine and Surgery to answer.
What distinguishes patients with LADA from type 1 and type 2 diabetics?
"LADA appears to be a mix of type 1 and type 2, with regard to both clinical picture and heredity. Genes have been found in LADA patients that are associated with type 1 diabetes, while others may be associated with type 2 diabetes."
How is the diagnosis made?
"It's adults, over the age of 35, who suffer from LADA. Like type 2 diabetics, it's generally overweight people who have high blood lipid levels and take too little exercise. Blood tests show that they have antibodies to the insulin-producing beta cells, something that is also seen in type 1 diabetes. Unlike type 1 diabetes, people with LADA do not need insulin from the start and are clinically often regarded as type 2 diabetics."
What are the principal risk factors?
"Hereditary factors, overweight, physical inactivity and age. Having diabetes in the family carries a four-fold higher risk. On the other hand, smoking, which is a risk factor for type 2 diabetes, appears to reduce the risk of LADA."
How are patients treated?
"At first usually as for type 2 diabetes, that is to say with advice on change of diet, exercise and drugs that increase insulin production and improve the uptake of insulin in the cells. Within a few years a large number of patients become dependent on treatment with insulin."
Can the treatment be improved?
"Yes, we hope so. At present we are preparing a major study together with colleagues in Lund and several centres in Norway. We are investigating whether insulin treatment initiated early can preserve the insulin production of the beta cells and in so doing provide better metabolic control and a lower risk of late complications."