Enhancing The Current Classification Of Diabetes

Diabetes is a chronic metabolic disease that has been around for centuries, even before the mechanisms were largely understood. In today’s day and age, there exists an enormous population of diabetic patients, close to five hundred million that are impacted across the globe. Unfortunately, this number is expected to rise dramatically in the forthcoming years resulting in billions of dollars of global expenditures for diabetes-related healthcare costs and excessive strain on the healthcare system. Therefore, with the advent of novel and emerging technologies that unite the intersection between the fields of technology and science that were once unimaginable, it goes without saying that we must push for a cure or improve treatment of this disease for the sake of our patient population.

This exceptionally large feat is of course not easy and will take both time and money. However, what it requires first is a better understanding of the disease on a biological level to one day advance the development of more effective therapeutics.

This recent article published in the journal, Diabetologia, explores interesting facets of Diabetes, that were once not explored that may help in developing a better course of treatment. We currently know of Diabetes largely centering around two main etiopathogenetic categories, I and II. Type I diabetes, which is called insulin-dependent diabetes mellitus (IDDM), is primarily due to a deficiency in insulin due to the autoimmune-mediated destruction of pancreatic β cells. Type II Diabetes Mellitus (T2DM), the most common form of diabetes, is a prevalent metabolic disorder and its pathogenesis is caused by a combination of peripheral insulin resistance and dysfunctional compensatory insulin secretory response from pancreatic β cells.

What we are now seeing is the demarcation of five subgroups (subtypes), namely severe autoimmune diabetes (SAID), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD). The SAID subgroup consists of individuals who are typically classified as type 1 diabetic, whereas SIDD, SIRD, MOD, and MARD individuals compromise novel entities of type 2 diabetes. This is such an important next step in our overall understanding of the disease pathogenesis as now having more specific subgroups we can understand the difference amongst patients having differing clinical outcomes and disease progression. That being said, it has the potential to allow for healthcare providers to develop a more unique and stratified set of treatment for each patient. Furthermore, with these specific classifications, we are also able to cluster people by their various trajectories in the onset of diabetes-related complications such as CKD, retinopathy, CVD, NAFLD, and neuropathies. With all this in mind, the differing pathophysiological phenotypes allow for individualized lifestyle-related and pharmacological treatment options.

For patients who classify under the SAID category, they could potentially require the early introduction of insulin supplementation, whereas SIDD patients may benefit from a dipeptidyl peptidase 4 inhibitor (DPP4i). To add on, both SIRD and MOD patients would benefit from medication that induces weight loss (SGLT2i, GLP-1RA, dual agonist) or also addresses the risk of CVD or nephropathy (SGLT2i, GLP-1RA). Lastly, patients with MARD should receive treatments avoiding weight loss and sarcopenia (e.g. protein-balanced diets and moderate resistance training).

The overall picture of diabetes should not be looked at as something black and white, but rather as a colorful spectrum with the different subgroups leading to different prognostics. This will allow us to develop innovative strategies that are more effective and provide precise personalized treatment options for patients.

Diabetes is a multifactorial disease that impacts the body and almost every organ system and due to the complex nature of the illness, there lie many gaps in the current body of knowledge surrounding the condition. With the combination of our understanding of the disease and the plethora of new methodological ways of studies, we can harness data from longitudinal and topological studies that will further highlight the pathophysiological hallmarks of type 2 diabetes and advance treatment from a clinical perspective.

References

[1] ER;, P. (n.d.). Type 2 diabetes: A multifaceted disease. Diabetologia. Retrieved February 25, 2022, from https://pubmed.ncbi.nlm.nih.gov/31161345/

[2] Herder, C., & Roden, M. (2022, January 4). A novel diabetes typology: Towards precision diabetology from pathogenesis to treatment - diabetologia. SpringerLink. Retrieved February 25, 2022, from https://link.springer.com/article/10.1007/s00125-021-05625-x

[3] L;, P. R. B. G. (n.d.). Precision medicine in type 2 diabetes. Journal of internal medicine. Retrieved February 25, 2022, from https://pubmed.ncbi.nlm.nih.gov/30403316/