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

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 choices for personalized therapies that target the individual mediating pathways of hyperglycemia at work in any given patient, without the risk of drug-related hypoglycemia or weight gain or imposing further burden on the β-cells. This article issues an urgent call for the review of the current DM classification system toward the consensus on a new, more useful system.

A 2-es típusú diabetes antihyperglykaemiás kezelésének alakulása Magyarországon 2001–2014 között – az Országos Egészségbiztosítási Pénztár adatbázis-elemzésének eredményei

“…Különösen a 2TDM kezelé-sére regisztrált készítmények tárháza bővült: új hatástani csoportok jelentek meg, az adott hatástani csoporton belül a készítmények száma is szaporodott, elérhetőkké váltak különböző hatástani csoportok képviselőinek fix kombinációi is [5,6]. A hazai gyógyszerellátási lehetősé-gek minimális időveszteséggel követték a nemzetközi trendeket, ez adódott abból is, hogy az új készítmények regisztrálása az Európai Unióban központilag történik.…”

Comment on Schwartz et al. The Time Is Right for a New Classification System for Diabetes: Rationale and Implications of the β-Cell–Centric Classification Schema. Diabetes Care 2016;39:179–186

“…Changes in the IGR may be due to any of the "Egregious Eleven" factors noted by Schwartz et al (1). It must be noted here that there is a bidirectional relationship of incretin and glucagon with the b-cell as opposed to the unidirectional arrow shown by the authors (1).…”

“…We appreciate the efforts by Schwartz et al (1) to synthesize current scientific knowledge in a simple and lucid manner and hope that the following suggestions will help improve the utility of their proposed b-cell-centric classification.…”

Once-weekly administration of dulaglutide, a glucagon-like peptide-1 receptor agonist, as monotherapy and combination therapy: review of the AWARD studies

“…Также было показано, что инкретины противодействуют слабо-выраженному воспалению, которое наблюдается у паци-ентов с СД [16]. У здоровых лиц уровень ГПП-1 в плазме повышается в два-три раза после приема пищи и до-стигает пика приблизительно через 20 мин после приема глюкозы внутрь и приблизительно через 60-90 мин после приема смешанной пищи [15].…”