Report of the Committee on the Classification and Diagnostic Criteria of Diabetes Mellitus

Abstract

Concept of Diabetes Mellitus:Diabetes mellitus is a group of diseases associated with various metabolic disorders, the main feature of which is chronic hyperglycemia due to insufficient insulin action. Its pathogenesis involves both genetic and environmental factors. The long‐term persistence of metabolic disorders can cause susceptibility to specific complications and also foster arteriosclerosis. Diabetes mellitus is associated with a broad range of clinical presentations, from being asymptomatic to ketoacidosis or coma, depending on the degree of metabolic disorder.Classification (Tables 1 and 2, and Figure 1):Table 1 Etiological classification of diabetes mellitus and glucose metabolism disordersI. Type 1 (destruction of pancreatic β‐cells, usually leading to absolute insulin deficiency) A. Autoimmune B. IdiopathicII. Type 2 (ranging from predominantly insulin secretory defect, to predominantly insulin resistance with varying degrees of insulin secretory defect)III. Due to other specific mechanisms or diseases (see Table 2 for details) A. Those in which specific mutations have been identified as a cause of genetic susceptibility (1) Genetic abnormalities of pancreatic β‐cell function (2) Genetic abnormalities of insulin action B. Those associated with other diseases or conditions (1) Diseases of exocrine pancreas (2) Endocrine diseases (3) Liver disease (4) Drug‐ or chemical‐induced (5) Infections (6) Rare forms of immune‐mediated diabetes (7) Various genetic syndromes often associated with diabetesIV. Gestational diabetes mellitusNote: Those that cannot at present be classified as any of the above are called unclassifiable.The occurrence of diabetes‐specific complications has not been confirmed in some of these conditions.Table 2 Diabetes mellitus and glucose metabolism disorders due to other specific mechanisms and diseasesA. Those in which specific mutations have been identified as a cause of genetic susceptibilityB. Those associated with other diseases or conditions(1) Genetic abnormalities of pancreatic β‐cell function Insulin gene (abnormal insulinemia, abnormal proinsulinemia, neonatal diabetes mellitus) HNF 4α gene (MODY1) Glucokinase gene (MODY2) HNF 1α gene (MODY3) IPF‐1 gene (MODY4) HNF 1β gene (MODY5) Mitochondria DNA (MIDD) NeuroD1 gene (MODY6) Kir6.2 gene (neonatal diabetes mellitus) SUR1 gene (neonatal diabetes mellitus) Amylin Others (2) Genetic abnormalities of insulin action Insulin receptor gene (type A insulin resistance, leprechaunism, Rabson–Mendenhall syndrome etc.) Others(1) Diseases of exocrine pancreas Pancreatitis Trauma/pancreatectomy Neoplasm Hemochromatosis Others (2) Endocrine diseases Cushing’s syndrome Acromegaly Pheochromocytoma Glucagonoma Aldosteronism Hyperthyroidism Somatostatinoma Others (3) Liver disease Chronic hepatitis Liver cirrhosis Others (4) Drug‐ or chemical‐induced Glucocorticoids Interferon Others (5) Infections Congenital rubella Cytomegalovirus Others (6) Rare forms of immune‐mediated diabetes Anti‐insulin receptor antibodies St...

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