Diabetes: Type Classification Needs Overhaul

A team of diabetes experts from centers across the country called for switching to a beta cell-based system to classify diabetes type in the Perspectives section of Diabetes Care, published online on January 21, 2016.

According to the team, led by Stanley S. Schwartz, MD, Associate Professor at the University of Pennsylvania and director of the Diabetes Program at the Philadelphia Heart Institute, the current classification system for diabetes is imperfect and makes diagnosis and treatment of the disease more difficult. According to the group, the current classifications — type 1 or low insulin production, type 2 or insulin resistance, gestational diabetes and latent autoimmune diabetes caused by other defects or disease – contain conflicts, and do not reflect advances in our understanding of the disease.

The team proposes a different system, based on the causes of the damage to the beta cells rather than insulin production or resistance. The group identifies 11 different pathways, including by inflammation, immune actions, gut biome, high fatty acids, high glucose levels, and genetics, which can contribute to beta cell dysfunction in the liver, adipose tissue, brain, colon, muscle, and immune system. This damage results in hyperglycemia as a result of increased glucose secretion and decreased insulin production and amylin levels.

This method of classification could improve treatment strategies by addressing the underlying causes, rather than just lowering the high glucose levels that result from them, the authors suggest, adding that physicians should aim to use the least amount of agents to target the greatest number of pathways. They also recommend avoid treatments that can further damage beta cells over the long term, such as sulfonylureas and glinides.

Understanding diabetes according to this system of classification may lead to more “rational choices for personalized therapies that target individual mediating pathways of hyperglycemia at work in any given patient,” the authors write. “This article issues an urgent call for the review of the current [diabetes mellitus] classification system toward consensus on a new, more useful system.”

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