Symposium 12:Heterogeneity of diabetes type 2: proposals to redefine it

Abstract

Diabetes is the fastest increasing disease worldwide. Existing treatment strategies have been unable to stop the progressive course of the disease and prevent development of chronic complications. One explanation for these shortcomings is that diagnosis of diabetes is based on measurement of only one metabolite, glucose, but the disease is heterogeneous with regard to clinical presentation and progression.

The distinction between the two types has historically been based on age at onset, degree of loss of β cell function, degree of insulin resistance, presence of diabetes-associated autoantibodies, and requirement for insulin treatment for survival. However, none of these characteristics unequivocally distinguishes one type of diabetes from the other, nor accounts for the entire spectrum of diabetes phenotypes. Thus, the phenotypes of T1DM and T2DM are becoming less distinctive with an increasing prevalence of obesity at a young age, recognition of the relatively high proportion of incident cases of T1DM in adulthood and the occurrence of T2DM in young people. Also, developments in molecular genetics have allowed clinicians to identify growing numbers of subtypes of diabetes.