Diabetes: an algorithm to assess the risk of the disease and help choose a treatment

Not all people with diabetes are the same, and their blood count tells us so. When analysed using a special algorithm – available free of charge online – this provides valuable insights into a patient’s risk levels, enabling targeted and more or less ‘robust’ treatments to be prescribed as early as the day after diagnosis and, above all, before complications arise, thereby preserving years of life and quality of life. All of this is achieved extremely quickly and in a cost-effective manner.

The ‘tailored’ approach – based on what experts refer to as the ‘immune identity card’, as revealed in a blood count and capable of predicting cardio-renal risk and mortality – is presented in an international study published on Cell Metabolism and authored by Riccardo Bonadonna, Professor of Endocrinology in Verona and President-elect of the Italian Society of Diabetology (SID).

The study involved around 70,000 people of European descent with type 2 diabetes, of whom over 1,500 had been newly diagnosed; their blood counts were analysed using a specialised algorithm, which enabled them to be categorised into four distinct immune profiles, each associated with a different risk of mortality and complications. The leukocyte profile (which, in a blood count, indicates the percentage of different circulating immune cells: neutrophils, lymphocytes, monocytes), when ‘analysed’ using a special algorithm, identified four distinct risk profiles (‘endotypes’), which are reproducible and stable over time: a severe inflammatory form (Sind), a mild inflammatory form (Mind), a lymphocyte-rich form (Lyrd) and a lymphocyte-deficient form (Lydd). The highest-risk profiles (Sind and Lydd) are characterised by inflammation driven by monocytes (the immune cells of the innate inflammatory response) and by impaired lymphocyte function. In these individuals, the innate immune system is hyperactivated, whilst the adaptive immune system is dysregulated; this dual imbalance may, over the years, contribute to the vascular and renal damage observed in the study.

People with type 2 diabetes who belong to the Sind and Lydd profiles have a significantly higher risk of experiencing cardiovascular events, impaired kidney function and mortality than the other two groups (Lyrd and Mind). And these differences are independent of age, sex, body weight or HbA1c levels: the ‘endotypes’ and the risk associated with them remain the same even after these factors have been controlled for, suggesting that they reflect an autonomous immune biology rather than simply ‘more advanced’ diabetes or a ‘more frail’ patient from the outset.