Evolution in Diagnosis and Classification of Diabetes

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.