Classification of diabetes mellitus

 

Classification of diabetes mellitus

In 1965, the WHO published a distinction between different types of diabetes in its "Recommendations for Classification and Diagnostics."

 

In 1997 the American Diabetes Society (ADA) changed the criteria for classification and diagnosis adopted by the WHO in 1998 and the German Diabetes Society (DDG) in 2000. The model no longer differentiated between insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). This classification only relates to the treatment and not its cause. Since 2009, the definition no longer distinguishes between subgroups a and b. The ranking of diabetes types from A to H was also abandoned.

 KEYWORD

Classification until 1997

Up to this date, diabetes mellitus was divided into four groups according to the type of treatment, the fifth indicating that the disease is absent:

 

·        NIR : (non-insulin-requiring) treatment without external insulin supply, e.g., B. only with diet and oral antidiabetic drugs.

·        IRC : (insulin-requiring for control) In addition to the body's insulin, external insulin is also required to lower elevated blood sugar levels.

·        IRS : (insulin-requiring for survival) External insulin supply is required for survival. According to the new classification, type 1 diabetes and order two diabetes significantly reduced or discontinued own insulin production.

·        IGT : (impaired glucose tolerance) impaired glucose tolerance.

·        ND : (nondiabetic) Not suffering from diabetes.

Types of diabetes since 1998

As of that date, all organizations have divided the disease into four types based on its cause:

 

Diabetes mellitus type 1: T-cell- mediated autoimmune disease with destruction especially of the beta cells of the islets of Langerhans in the pancreas; this usually leads to an absolute insulin deficiency

Diabetes mellitus type 2: different combinations of insulin resistance, hyperinsulinism, relative insulin deficiency, secretion disorders

·        Type 2a: without obesity (obesity)

·        Type 2b: with obesity

Other specific types of diabetes

Ø  A: genetic defects in the beta cells of the islets of Langerhans (impaired insulin secretion)

Ø  B: rare genetic defects in the action of insulin

Ø  C: Diseased or destroyed pancreas

Ø  D: diabetes due to hormonal disorders (endocrinopathies)

Ø  E: diabetes from drugs or chemicals (drugs, poisons)

Ø  Q: Diabetes mellitus due to infections

Ø  G: unusual forms of immune-mediated diabetes

Ø  H: other genetic syndromes associated with diabetes

·        Gestational diabetes (gestational diabetes)

Diabetes types according to the guidelines of the DDG 2009

Based on the report of the WHO commission from 1999, classification is made according to the guidelines of the DDG 2009 [8] using the following criteria:

 

·        Type 1 diabetes mellitus: Destruction of the beta cells in Langerhans' islets in the pancreas leads to an absolute insulin deficiency.

·        Type 2 diabetes mellitus: Can range from (genetically determined) insulin resistance with a relative insulin deficiency to an absolute insulin deficiency in the later course of the disease. It is often associated with other metabolic syndrome problems.

·        Other specific types of diabetes

·        Exocrine pancreatic disorders (e.g., pancreatitis, cystic fibrosis, hemochromatosis )

·        Endocrinopathies (e.g., Cushing's syndrome, acromegaly, pheochromocytoma )

·        Drug-chemically induced (e.g., glucocorticoids, neuroleptics, alpha interferon, pentamidine )

·        Genetic defects in β-cell function (e.g., MODY forms)

·        Genetic defects in the action of insulin

·        Other genetic syndromes that may be associated with diabetes

·        Rare forms of autoimmune-mediated diabetes.

·        Gestational diabetes: Glucose tolerance disorder appeared or was first diagnosed during pregnancy. This includes:

·        The initial manifestation of type 1 diabetes

·        The first manifestation of type 2 diabetes

·        The initial onset of other specific types of diabetes

·        Preconceptionally manifest but undiagnosed diabetes mellitus (type 2), especially in glucose tolerance disorders, as early as the 1st trimester.

This classification was confirmed in 2011 as part of an update of the guidelines by the DDG. [8th]

 

More terms

·        Adolescent diabetes (English: juvenile diabetes mellitus ) or "juvenile diabetes mellitus" is the outdated term for type 1 diabetes.

·        Age diabetes (English: Adult-Onset Diabetes mellitus ) or "adult diabetes" used to be called type 2 diabetes. Both terms are still widely used but do not correspond to state of the art and are therefore no longer included in the current classifications.

·        LADA: LADA ( latent autoimmune diabetes with onset in adults ) also belongs to type 1 diabetes mellitus. This form affects autoimmune diabetes, which develops in later adulthood, which no longer reacts to oral medication and requires insulin after a relatively short time. The detection of the GAD (= glutamate decarboxylase ) antibody is typical.

·        MODY: MODY ( maturity-onset diabetes of the young ) corresponds to the course of type 2 diabetes, but without the occurrence of obesity and insulin resistance; it already occurs in children and adolescents.

·        IDDM: Abbreviation for insulin-dependent diabetes mellitus. Traditional but still widespread classification according to the type of therapy required.

·        NIDDM: Abbreviation for noninsulin-dependent diabetes mellitus. Traditional but still widespread classification according to the type of therapy required.