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3 Reclassifying or Declassifying Diabetes? Can Clinical Characteristics Guide Classification and Treatment?
Adrian Vella
Professor of Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
LEARNING POINTS
Type 2 diabetes is differentiated from type 1 diabetes by what it is not i.e. a lack of evidence of immune‐mediated destruction of insulin‐secreting cells. This oversimplification may miss some of the heterogeneity present in type 2 diabetes.
Current methods of differentiating type 1 from type 2 diabetes have significant limitations and lack sensitivity and specificity.
Glucose‐ and lipo‐toxicity can adversely affect insulin secretion in the short term although this state of affairs is not necessarily permanent.
Attention to a possible diagnosis of monogenic diabetes and achieving glycemic control safely and effectively are more likely to be clinically relevant than current attempts to sub‐classify type 2 diabetes.
The pathophysiology of hyperglycemia – type 1 vs type 2 diabetes
It is important to appreciate that the classification of type 1 and type 2 diabetes was originally somewhat arbitrary and has now evolved into a “positive” diagnosis of type 1 diabetes – based on the presence of autoantibodies
