RHAPSODY

Building on ground-breaking results from IMI diabetes projects, scientists are now working on a software tool that would identify what subtype of diabetes a patient has, and suggest which treatment would work best for them.###

For many years, the medical world has recognised two main types of diabetes: type 1 and type 2. However, research funded in part by IMI through the BEAt-DKD and RHAPSODY projects paints a different picture, suggesting that there are not two subtypes of diabetes, but five. The scientists have since validated these initial findings in additional patient populations, and several studies are currently ongoing to test the effects of different treatments on the different diabetes subtypes.

Meanwhile, investigators have developed a software tool, which is currently used for research purposes and is soon to be implemented in the clinic, to allow doctors to identify which diabetes subtype the patient has. The researchers have received funding from other sources beyond IMI to carry out these additional studies. All in all, this story shows how IMI projects can deliver ground-breaking results, validate them, and turn them into a tool that can hopefully assist in providing the right treatment for the right patient at the right time.

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Diabetes is a chronic and incurable illness linked to blood sugar that has traditionally been divided into type 1 and type 2. Type 2 accounts for the vast majority of cases – some 285 million – and its prevalence is expected to soar over the coming decade. Amid this backdrop, IMI's RHAPSODY project set out to look more closely at type 2 in a bid to develop targeted treatments for the condition, which can vary significantly and cause serious complications such as kidney failure. ###In a major development, RHAPSODY – in conjunction with others including IMI's BEAT-DKD project – has broken type 2 diabetes down into five subgroups which need different treatments and have different progressions. And this, the researchers believe, has the potential to revolutionise how doctors deal with diabetics. ‘What RHAPSODY is really about is individualising diabetes treatment,’ says vice project coordinator Leif Groop of Lund University in Sweden. ‘For too long, we have had the situation that one size fits all.’  The subgroups grew out of a Swedish study known as ANDIS involving more than 13 000 diabetics and initiated by Groop. It monitored not only patients' blood sugar but also factors such as insulin resistance and secretion, as well as age. The study has since been replicated, including in China.

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• Visit the BEAT-DKD factsheet and website
• Visit the RHAPSODY factsheet and website

Scientists have identified five subtypes of diabetes, a finding that will pave the way for more personalised treatments for the disease. The work, published in The Lancet Diabetes and Endocrinology, was funded in part by IMI through the projects BEAT-DKD and RHAPSODY. ###Currently, two main types of diabetes are recognised, and diagnosis is through a measurement of a patient’s blood sugar levels. In this study, scientists monitored over 13 000 newly-diagnosed diabetes patients, analysing blood sugar levels, insulin resistance, insulin secretion, and age of onset among other things. This revealed five distinct groups of patients with different risk levels for certain complications associated with diabetes. For example, patients in group 2 (‘severe insulin-deficient diabetes’) are at greatest risk of eye disease, while patients in group 3 (‘severe insulin-resistant diabetes’) had the highest incidence of kidney damage. ‘Current diagnostics and classification of diabetes are insufficient and unable to predict future complications or choice of treatment,’ said Leif Groop of Lund University in Sweden. ‘This is the first step towards personalised treatment of diabetes.’ Until now, the team has only studied people in Sweden and Finland; they now plan to carry out similar studies in China and India, to see if their findings apply in different ethnic groups.