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Diabetes at the crossroads: relevance of disease classification to pathophysiology and treatment.

Leslie, R David; Palmer, Jerry; Schloot, Nanette C and Lernmark, Åke LU (2016) In Diabetologia 59(1). p.13-20
Abstract
Diabetes is not a single homogeneous disease but composed of many diseases with hyperglycaemia as a common feature. Four factors have, historically, been used to identify this diversity: the age at onset; the severity of the disease, i.e. degree of loss of beta cell function; the degree of insulin resistance and the presence of diabetes-associated autoantibodies. Our broad understanding of the distinction between the two major types, type 1 diabetes mellitus and type 2 diabetes mellitus, are based on these factors, but it has become apparent that they do not precisely capture the different disease forms. Indeed, both major types of diabetes have common features, encapsulated by adult-onset autoimmune diabetes and maturity-onset diabetes of... (More)
Diabetes is not a single homogeneous disease but composed of many diseases with hyperglycaemia as a common feature. Four factors have, historically, been used to identify this diversity: the age at onset; the severity of the disease, i.e. degree of loss of beta cell function; the degree of insulin resistance and the presence of diabetes-associated autoantibodies. Our broad understanding of the distinction between the two major types, type 1 diabetes mellitus and type 2 diabetes mellitus, are based on these factors, but it has become apparent that they do not precisely capture the different disease forms. Indeed, both major types of diabetes have common features, encapsulated by adult-onset autoimmune diabetes and maturity-onset diabetes of the young. As a result, there has been a repositioning of our understanding of diabetes. In this review, drawing on recent literature, we discuss the evidence that autoimmune type 1 diabetes has a broad clinical phenotype with diverse therapeutic options, while the term non-autoimmune type 2 diabetes obscures the optimal management strategy because it encompasses substantial heterogeneity. Underlying these developments is a general progression towards precision medicine with the need for precise patient characterisation, currently based on clinical phenotypes but in future augmented by laboratory-based tests. Key points • The need to clarify diabetes classification, which is currently imprecise in distinguishing major disease types, using laboratory tests • The importance of predictors of disease progression, including genetic, immune and metabolic features • The potential for predicting therapeutic responses to provide a more personalised approach to therapy. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Diabetologia
volume
59
issue
1
pages
13 - 20
publisher
Springer Verlag
external identifiers
  • pmid:26498592
  • wos:000365804500004
  • scopus:84949319141
ISSN
1432-0428
DOI
10.1007/s00125-015-3789-z
language
English
LU publication?
yes
id
9fba8537-2ee2-4ec7-8d3a-35fbdbdf1196 (old id 8148406)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26498592?dopt=Abstract
date added to LUP
2015-11-03 20:48:49
date last changed
2017-10-29 03:17:05
@article{9fba8537-2ee2-4ec7-8d3a-35fbdbdf1196,
  abstract     = {Diabetes is not a single homogeneous disease but composed of many diseases with hyperglycaemia as a common feature. Four factors have, historically, been used to identify this diversity: the age at onset; the severity of the disease, i.e. degree of loss of beta cell function; the degree of insulin resistance and the presence of diabetes-associated autoantibodies. Our broad understanding of the distinction between the two major types, type 1 diabetes mellitus and type 2 diabetes mellitus, are based on these factors, but it has become apparent that they do not precisely capture the different disease forms. Indeed, both major types of diabetes have common features, encapsulated by adult-onset autoimmune diabetes and maturity-onset diabetes of the young. As a result, there has been a repositioning of our understanding of diabetes. In this review, drawing on recent literature, we discuss the evidence that autoimmune type 1 diabetes has a broad clinical phenotype with diverse therapeutic options, while the term non-autoimmune type 2 diabetes obscures the optimal management strategy because it encompasses substantial heterogeneity. Underlying these developments is a general progression towards precision medicine with the need for precise patient characterisation, currently based on clinical phenotypes but in future augmented by laboratory-based tests. Key points • The need to clarify diabetes classification, which is currently imprecise in distinguishing major disease types, using laboratory tests • The importance of predictors of disease progression, including genetic, immune and metabolic features • The potential for predicting therapeutic responses to provide a more personalised approach to therapy.},
  author       = {Leslie, R David and Palmer, Jerry and Schloot, Nanette C and Lernmark, Åke},
  issn         = {1432-0428},
  language     = {eng},
  number       = {1},
  pages        = {13--20},
  publisher    = {Springer Verlag},
  series       = {Diabetologia},
  title        = {Diabetes at the crossroads: relevance of disease classification to pathophysiology and treatment.},
  url          = {http://dx.doi.org/10.1007/s00125-015-3789-z},
  volume       = {59},
  year         = {2016},
}