What if diabetes wasn't just one condition with two types, but a whole bunch of diseases under the same label?
That's the conclusion of new research, and it could revolutionise the way we detect and treat diabetes in the future.
Analysing past studies covering a total of 14,775 type 1 and type 2 adult-onset diabetes patients across Sweden and Finland, scientists have found five different and distinct disease profiles, including three severe and two mild forms of the condition.
The more precise we can be about different categories of diabetes, the better we can understand and treat it, according to the team of researchers from Scandinavia
It might even give doctors an earlier window of opportunity for preventing the onset of diabetes.
"Evidence suggests that early treatment for diabetes is crucial to prevent life-shortening complications," says senior researcher Leif Groop, from the Lund University Diabetes Centre (LUDC) in Sweden.
"More accurately diagnosing diabetes could give us valuable insights into how it will develop over time, allowing us to predict and treat complications before they develop."
Six different measurements were used across four separate studies: age at diagnosis, body mass index (BMI), long-term glycaemic (blood sugar) control, the function of insulin-producing cells in the pancreas, insulin resistance, and the presence of specific autoantibodies linked to autoimmune diabetes.
Instead of splitting diabetes simply into type 1 and type 2, the researchers came up with five different disease profiles - one autoimmune type of diabetes and four other distinct subtypes. All five types were found to be genetically distinct, with no shared mutations.
This is enough to suggest we're looking at five distinct diseases that all affect the same body system, rather than the same disease at different stages of progression, say the researchers.
So how did they differ? One of the three more serious forms was a group of people with severe insulin resistance and a significantly higher risk of kidney disease. Another more mild type was seen mostly in elderly people.
You can see how those distinctions could improve the way we tackle diabetes – by identifying the types of patients involved and the complications they're at risk from, doctors could work out more personalised courses of treatment.
Indeed, the researchers found that many in the study weren't being given the right treatment for the particular characteristics of the diabetes they had.
With diabetes now the fastest-growing disease on the planet, more options for dealing with it can't come soon enough. More than 420 million people are now thought to have diabetes worldwide.
Between 75-85 percent of people with diabetes have the more common type 2, where the body can't produce enough insulin to cope with levels of insulin resistance.
The researchers do note some limitations though: there's no evidence yet that these five types of diabetes have different causes, and the sample only included Scandinavian patients, so a wider study is going to be required to investigate this further.
"Existing treatment guidelines are limited by the fact they respond to poor metabolic control when it has developed, but do not have the means to predict which patients will need intensified treatment," says Groop.
"This study moves us towards a more clinically useful diagnosis, and represents an important step towards precision medicine in diabetes."
The research has been published in The Lancet Diabetes & Endocrinology.