Abstract
Diabetes, has been known to mankind for centuries, often described by its unique nature of sweet tasting urine or by the symptoms of excessive urination and thirst. Several renowned scientists have attempted to describe the symptoms, pathophysiology, diagnosis and various experimental treatment options with varying degrees of success. The current widely accepted classification focuses on etiology and pathogenesis to guide treatment and is very successful and adapted across the world. Diagnostic criteria underwent multiple changes to define glycemic targets which were more and more guided by better understanding of the disease pathogenesis. Recent research focuses on a more individualized approach to managing diabetes, better understanding and identifying individuals who are at an increased risk of complications at diagnosis itself to offer more personalized management to prevent long term complications. Early differentiation of individual based on multiple factors rather than a single parameter is the path being paved currently. BMI, Waist circumference, age at diagnosis, HbA1c, triglycerides, HDL cholesterol, GAD Antibodies, Homeostasis model assessment of Insulin Resistance (HOMA-2 IR), beta-cell dysfunction (HOMA2-Beta), and fasting and stimulated C-peptide, are core parameters in the current rationalized approach towards better long term outcomes for people with diabetes. Cluster based identification and focused treatment with individualistic targets is the way forward in Diabetes management.
Highlights
It was in the early 5th and 6th century that diabetes was first noted by Ayurvedic scientists Sushruta and Charaka, they defined this illness by the characteristic of sweet tasting urine, described as “Madhumeha” or “honey urine”
Recent research focuses on a more individualized approach to managing diabetes, better understanding and identifying individuals who are at an increased risk of complications at diagnosis itself to offer more personalized management to prevent long term complications
Diabetes HbA1c Clusters GAD Antibodies C Peptide
Summary
It was in the early 5th and 6th century that diabetes was first noted by Ayurvedic scientists Sushruta and Charaka, they defined this illness by the characteristic of sweet tasting urine, described as “Madhumeha” or “honey urine”. Lancereux were able to distinguish between different patient types, notable patients who had more severe symptoms, were lean and expected to have poorer outcomes along with pancreatic lesions on autopsy as against another type of patient group who had a milder form of disease, were overweight and presented at a later stage in life and expected to have a much better prognosis [6]. These descriptions are comparable to the two types identified by Ayurvedic physicians Sushruta and Charka (400-500 AD), with one type being associated with youth and the other with being overweight. Philip Hugh-Jones, while working in Jamaica in 1955, clarified Lawrence’s classification and coined the terms “type 1” and “type 2” diabetes [9]
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