Expanding diabetes classification - new subtypes and therapeutic options

Abstract

Diabetes mellitus is a disorder, which was known since the antiquity. Not before the 20th century the breakthrough in management of this formerly lethal condition was achieved. The last century brought a better understanding of the pathogenesis and the heterogeneity of multiple disorders constituting distinct types of diabetes. In 1999 The Expert Committee of the World Health Organization has adopted the etiology-based classification of diabetes mellitus, which is commonly accepted nowadays. With the recent progression in understanding of the molecular basis of diabetes, especially the genetics of its rare forms, the etiologic classification expands rapidly. Newly described monogenic forms of diabetes mellitus, such as MODY, mitochondrial diabetes, neonatal diabetes, and lipoatrophic types of diabetes are characterized by certain distinct clinical features. In many cases, it is possible to adjust a specific therapeutic intervention to optimally manage the genetic defect and subsequent metabolic abnormalities. Molecular diagnosis plays an increasing role in contemporary diabetology, and in future it may become a standard procedure in certain clinical situations.