Classification of Diabetes: Not All Hyperglycemia is the Same

Abstract

D uring internship and residency, physicians-in-training encounter a myriad of diseases and symptoms. As discussed in this space in the previous issue of Clinical Diabetes ,1 diabetes is a major issue in U.S. health care and is growing rapidly. Medical professionals can expect to spend a large portion of their time caring for diabetic patients in the inpatient and outpatient settings as the prevalence of this disease increases steadily. Central to the treatment of patients with diabetes is understanding the classification system used to describe diabetes. Previously, physicians classified diabetes based on the treatment required to control the disorder (insulin-dependent versus non-insulin-dependent diabetes) or age at which the disorder develops (e.g., juvenile diabetes or late-onset autoimmune diabetes of adulthood). As our understanding of diabetes has deepened, the diagnostic criteria and classification scheme of diabetes has changed as well. Different therapies now target the underlying mechanisms of diabetes, such as insulin deficiency, insulin resistance, and other aspects of the disease process. To improve the health care of people with diabetes, the American Diabetes Association (ADA) no longer recommends classification of diabetes based on treatment of hyperglycemia, but rather on underlying mechanism.2,3 The underlying mechanisms of diabetes were discussed in detail in the last issue;1 this article will focus on the classification scheme for diabetes, which is important for several reasons. In addition to offering expedient and up-to-date health care for patients, there are other important reasons to have a thorough understanding of the classification of diabetes. Diagnosis of diabetes can have a major impact on the cost of an individual's health insurance premium. In many situations, patients with diabetes may even be considered uninsurable, which limits their options for self-employment or in obtaining insurance for their family. There are also important ramifications in other areas, such …