Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis

Abstract

The American Diabetes Association, JDRF, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists convened a research symposium, “The Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis” on 10–12 October 2015. International experts in genetics, immunology, metabolism, endocrinology, and systems biology discussed genetic and environmental determinants of type 1 and type 2 diabetes risk and progression, as well as complications. The participants debated how to determine appropriate therapeutic approaches based on disease pathophysiology and stage and defined remaining research gaps hindering a personalized medical approach for diabetes to drive the field to address these gaps. The authors recommend a structure for data stratification to define the phenotypes and genotypes of subtypes of diabetes that will facilitate individualized treatment.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2018

“…Once hyperglycemia occurs, patients with all forms of diabetes are at risk for developing the same chronic complications, although rates of progression may differ. The identification of individualized therapies for diabetes in the future will require better characterization of the many paths to b-cell demise or dysfunction (4).…”

“…Glucose and A1C levels rise well before the clinical onset of diabetes, making diagnosis feasible well before the onset of DKA. Three distinct stages of type 1 diabetes can be identified ( Table 2.1) and serve as a framework for future research and regulatory decision-making (4,5).…”

“…Type 2 diabetes is primarily associated with insulin secretory defects related to inflammation and metabolic stress among other contributors, including genetic factors. Future classification schemes for diabetes will likely focus on the pathophysiology of the underlying b-cell dysfunction and the stage of disease as indicated by glucose status (normal, impaired, or diabetes) (4).…”

2. Classification and Diagnosis of Diabetes

“…In October 2015, the ADA, JDRF, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists convened the Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis Research Symposium (4). The goals of the symposium were to discuss the genetic and environmental determinants of type 1 and type 2 diabetes risk and progression, to determine appropriate therapeutic approaches based on disease pathophysiology and stage, and to define research gaps hindering a personalized approach to treatment.…”

Precision diabetes treatment comes a step closer

“…Despite their different origins, the pathways end at a common destination: hyperglycaemia. 4 According to Leif Groop, Senior Professor in Endocrinology at Lund University and Research Director at Helsinki University, who led the new study, this heterogeneity might help explain why, despite current treatments, diabetes often progresses and why so many patients develop complications.…”