To facilitate a more personalized medical approach to diabetes, the American Diabetes Association announces publication of a report that paves the way for defining subtypes of diabetes. The report details the outcomes of a symposium convened by the American Diabetes Association, that included leadership from JDRF, the European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists. The symposium examined the current research on the various pathophysiological routes that ultimately result in diabetes, and how these different pathways may be better characterized to allow precise, personalized treatment for people with diabetes.
The complete article, “Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis” (Differentiation), has been published in Diabetes online at http://dx.doi.org/10.2337/db16-0806 on Dec. 15, 2016. The report is based on presentations, discussions and consensus research recommendations from the gathering of international experts in genetics, immunology, metabolism, endocrinology and systems biology.
“The expert consensus is that the unifying characteristic of the vast majority of diabetes is hyperglycemia (high blood sugar) resulting from β-cell (beta cell) destruction or dysfunction,” said Robert E. Ratner, MD, FACP, FACE, chief scientific and medical officer of the Association. “With a better understanding of how various factors affect the number and function of β-cells, we may be able to classify subtypes of the diseases, predict the rate of progression and identify where and how interventions can be targeted to prevent or delay disease progression and complications.”
The report highlights research that indicates that the persistence of two or more autoantibodies accurately predicts the onset of hyperglycemia in type 1 diabetes and recommends that this stage be adopted as an earlier clinical diagnosis of the disease. Defining type 1 diabetes at this earlier point has the potential of markedly reducing ketoacidosis—a life-threatening complication of diabetes that often occurs at diagnosis and produces dangerously high levels of blood acids called ketones.
The paths to β-cell dysfunction in type 2 diabetes are less well-defined at this time, and the report indicates that classification schemes for type 2 diabetes will need to focus on both the pathophysiology of the underlying β-cell dysfunction, as well as the stage of disease as indicated by glucose status and complications.
The publication outlines future directions and research resources that will be required to move the field forward, and identifies a number of critical questions that need to be answered to advance further characterization schemes. Many of the questions identified by the group focus on enhancing the understanding of β-cell dysfunction, including identifying at what point β-cell demise becomes irreversible and understanding the mechanistic underpinnings of how β-cells die or fail in the presence of autoimmunity and inflammation.
“Diabetes is an extremely complex set of diseases with a variety of genetic and environmental contributors. While the oncology field has begun to effectively leverage advanced insights into the pathophysiology of different types of cancer to develop highly tailored tools for diagnosis and therapy, the diabetes field currently lacks sufficient information for specific personalized treatment approaches,” said Tamara Darsow, PhD, a lead author of the report and vice president of research programs and outcomes research of the Association. “By better understanding and distinguishing subtypes of diabetes based on pathophysiology, we hope to move the field forward in a way that can inform individual treatment decisions. We call upon experts in the field to address the research gaps outlined in this report as a critical starting point.”
The complete report has been published online at http://dx.doi.org/10.2337/db16-0806 on Dec. 15, 2016 and in an upcoming print issue of Diabetes.
Diabetes is a monthly, peer-reviewed journal of the American Diabetes Association that publishes original research about the physiology and pathophysiology of diabetes. Emphasis is on investigative reports focusing on areas such as the pathogenesis of diabetes and its complications, normal and pathologic pancreatic islet function and intermediary metabolism, pharmacological mechanisms of drug and hormone action, and biochemical and molecular aspects of normal and abnormal biological processes. “Perspectives on Diabetes” provide readers with novel reviews and commentaries on diabetes-related research. Diabetes is the top-ranked journal devoted exclusively to diabetes research.
The American Diabetes Association is leading the fight to Stop Diabetes® and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, the Association’s mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes.
SOURCE American Diabetes Association