Diagnosis, Classification, and Lifestyle Treatment of Diabetes

Abstract

During internship and residency, young physicians encounter a myriad of diseases and symptoms in the course of training. As discussed in the previous installment of this series ( Clinical Diabetes 27:160–163, 2009), 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 inpatient and outpatient settings as the prevalence of this disease increases steadily. Central to the treatment of patients with diabetes is the understanding of the disease itself. 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 (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 the underlying mechanism involved.1,2 The underlying mechanisms of diabetes were discussed in detail in our previous installment. This issue 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. A diagnosis of diabetes can have a major effect on the cost of an individual's health insurance premiums. In many situations, patients with diabetes may even be considered uninsurable, which limits their ability to become self-employed or to obtain insurance for their family. There are also important ramifications in …