New Diabetes Classification System

Rationale and Implications of the β-Cell–Centric Classification Schema

The current classification system presents challenges to the diagnosis and treatment of patients with diabetes mellitus (DM), in part due to its conflicting and confounding definitions of type 1 DM, type 2 DM, and latent autoimmune diabetes of adults (LADA). The current schema also lacks a foundation that readily incorporates advances in our understanding of the disease and its treatment. Experts calling for new diabetes classification system.

The new method would make β-cell centric classification of diabetes a single common denominator for all types. At present, the classification identifies only four types of diabetes mellitus. These are type 1, type 2, ‘other specific types’ (which include genetic defects of beta-cell function, genetic defects in insulin action, diseases of exocrine pancreas and more) and gestational diabetes.

Based on new research performed by Stanley Schwartz and affiliates (according to a new article published online in Diabetes Care Jan. 21, 2016), there is a new proposition for using a β-cell centered model for diabetes, which supports the notion that all diabetes originates from an abnormal pancreatic β-cell. Type 1 diabetes has been thought of as an ailment of low insulin production, while type 2 has usually been of insulin resistance. This discrepancy is not clear or helpful. Schwartz and colleagues suppose all diabetes is a product of impairment to beta cells (which produce insulin) and according to this theory, insulin resistance just reveals the rudimentary deficiency in insulin production.

Schwartz believes that diabetes is rooted to β-cell and because of this, classification of diabetes types should be based on causes of that damage so physicians will know how to go about treatment. This “β-cell centric” criterion recognizes that β-cell damage can be caused by inflammation, immune actions, gut biome, high fatty acids, high glucose levels, genetics and other causes; categorization founded on these sources can help cultivate an improved treatment strategy, as opposed to simply knocking down an individual’s glucose level.

Further Experimental and Translational Research

A β-cell–focused schema can integrate knowledge to date and incorporate new discoveries. It can provide sage advice for preferential use of pharmacological interventions that address the mechanisms of hyperglycemia operative in an individual patient, avoid hypoglycemia and weight gain, and appear to be β-cell sparing. Preferred therapies will be those that affect multiple mediators of hyperglycemia. Novel anti-inflammation agents currently in phase 2 and 3 clinical development should be evaluated for safety and efficacy.

The β-cell–centric classification schema was envisioned as a stimulus to guide basic research, as well as clinical and translational research. It is hoped to help direct research on the genes involved in DM, the functions that these genes serve, the mechanisms that lead to β-cell damage, the downstream effects of reduced β-cell function, and any novel mechanisms of β-cell pathophysiology. Also needed is research toward improved diagnostic markers for the development of DM.

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