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

摘要

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 beta-cell-centric classification of DM is a new approach that obviates the inherent and unintended confusions of the current system. The beta-cell-centric model presupposes that all DM originates from a final common denominator-the abnormal pancreatic beta-cell. It recognizes that interactions between genetically predisposed beta-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 beta-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 beta-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.