The Time Is Right for a New Classification System for Diabetes: Rationale and Implications of the β-Cell-Centric Classification Schema

Diabetes Care
Stanley S SchwartzRichard B Aguilar

Abstract

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. For appropriate and coherent therapy, we propose an alternate classification system. The β-cell-centric classification of DM is a new approach that obviates the inherent and unintended confusions of the current system. The β-cell-centric model presupposes that all DM originates from a final common denominator-the abnormal pancreatic β-cell. It recognizes that interactions between genetically predisposed β-cells with a number of factors, including insulin resistance (IR), susceptibility to environmental influences, and immune dysregulation/inflammation, lead to the range of hyperglycemic phenotypes within the spectrum of DM. Individually or in concert, and often self-perpetuating, these factors contribute to β-cell stress, dysfunction, or loss through at least 11 distinct pathways. Available, yet underutilized, treatments provide rational choic...Continue Reading

References

May 9, 2000·Biochemical and Biophysical Research Communications·T IwakuraY Seino
Oct 16, 2004·The Journal of Clinical Endocrinology and Metabolism·Kathrin MaedlerMarc Y Donath
Dec 24, 2005·The New England Journal of Medicine·David M NathanUNKNOWN Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research
Jun 20, 2006·Biochemical and Biophysical Research Communications·Junqin ChenAnath Shalev
Apr 13, 2007·The New England Journal of Medicine·Claus M LarsenMarc Y Donath
Oct 16, 2007·Diabetes Research and Clinical Practice·Kenji NonakaPeter P Stein
Jul 10, 2008·Pharmacoepidemiology and Drug Safety·David J MargolisBrian L Strom
Dec 17, 2009·Diabetic Medicine : a Journal of the British Diabetic Association·S Del Prato
Apr 21, 2010·Nature Reviews. Endocrinology·Harold E Lebovitz
Sep 22, 2010·Nature Immunology·Thomas Mandrup-Poulsen
Feb 10, 2011·Annals of Nutrition & Metabolism·Sergio Muntoni, Sandro Muntoni
Jun 15, 2011·Diabetology & Metabolic Syndrome·Boris Draznin
Jul 9, 2011·Diabetes, Obesity & Metabolism·C J Currie, J A Johnson
Oct 1, 2011·Diabetes, Obesity & Metabolism·R A DeFronzoS Del Prato
Oct 21, 2011·The Journal of Clinical Endocrinology and Metabolism·Ajay ChaudhuriParesh Dandona
Nov 10, 2011·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·John ArmatoRon Ruby
Jun 30, 2012·The Journal of Clinical Endocrinology and Metabolism·Antoine MakdissiParesh Dandona
Jan 4, 2013·Diabetes/metabolism Research and Reviews·Chiara GuglielmiPaolo Pozzilli
Jan 26, 2013·Diabetes·Maria J Redondo
Jul 11, 2013·Mediators of Inflammation·Bruno Melo Carvalho, Mario Jose Abdalla Saad
Aug 2, 2013·Diabetes Care·Ralph A DeFronzoMuhammad Abdul-Ghani
Aug 6, 2013·Diabetes, Obesity & Metabolism·J P H WildingUNKNOWN Dapagliflozin 006 Study Group
Dec 10, 2013·Lancet·Tiinamaija TuomiLeif Groop
Jan 1, 2014·Journal of Clinical Research in Pediatric Endocrinology·Kimberly Sue TafuriThomas Allen Wilson
Jan 29, 2014·Nature Reviews. Endocrinology·Bart O Roep, Timothy I M Tree
Apr 16, 2014·The Lancet. Diabetes & Endocrinology·Markus SchlaichGavin Lambert
Apr 16, 2014·The Lancet. Diabetes & Endocrinology·Kaixin ZhouEwan R Pearson

❮ Previous
Next ❯

Citations

Jul 17, 2018·Current Diabetes Reviews·Ingrid K Hals
Jul 12, 2019·Current Diabetes Reports·Miriam S Udler
Jul 20, 2019·Endocrine Reviews·Miriam S UdlerAnubha Mahajan
Jan 31, 2018·Diabetes, Obesity & Metabolism·Anne Cathrine B Thuesen, Allan Vaag
Jan 8, 2019·BMJ Open Diabetes Research & Care·Abdallah Ahmed GunaidAhmed Nasser Al-Radaei
Dec 22, 2019·Diabetes Care·UNKNOWN American Diabetes Association
Jul 17, 2016·Journal of Evaluation in Clinical Practice·Joachim P SturmbergMartin Picard
Jul 28, 2016·Current Diabetes Reports·Jakob Appel ØstergaardR David Leslie
Apr 14, 2017·Nature Communications·Seung Ho LeeYoung Bin Choy
May 12, 2017·Anais Da Academia Brasileira De Ciências·Luís M T R Lima
Sep 27, 2018·World Journal of Diabetes·Carolina BelosoAdriana Mimbacas
Dec 7, 2018·Hormones : International Journal of Endocrinology and Metabolism·Jihad A Haddad, Aiman N Haddad
Feb 7, 2019·Expert Review of Endocrinology & Metabolism·Juan Pablo Frias
Apr 3, 2020·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Melody L HartzlerLara Zakaria
Jul 9, 2016·Nature Reviews. Endocrinology·Paul ZimmetPeter H Bennett
Dec 22, 2016·Diabetes Care·William T CefaluMatthew C Riddle
Apr 23, 2017·Current Environmental Health Reports·Mizuho S MimotoRobert M Sargis
May 23, 2017·International Scholarly Research Notices·Bruno Moukette MouketteConstant Anatole Pieme
Jun 8, 2017·Expert Opinion on Investigational Drugs·Kalliopi PafiliNikolaos Papanas
Feb 9, 2018·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Blanca Colín-LozanoGabriel Navarrete-Vazquez
Mar 2, 2018·Therapeutic Advances in Endocrinology and Metabolism·Wesley NufferJennifer M Trujillo
Oct 18, 2018·Expert Review of Endocrinology & Metabolism·Donald A Williamson
Jan 11, 2020·Frontiers in Endocrinology·Stephen H Sinclair, Stanley S Schwartz
Sep 3, 2020·International Journal of Molecular Sciences·Unai Galicia-GarciaCésar Martín

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