Abstract
Classifications of disease are man-made devices to assist in the ordering of thought or the organization of action. It follows that they depend upon the current state of knowledge and that as knowledge increases so classification may change. It also follows that the nature of the classification will depend upon the type of action to be organized. Thus a classification appropriate to a clinician whose concern is with diagnosis and treatment may well be inappropriate to a basic scientist whose concern is research strategy and experimental design. The public health agent will require a classification which assists in provision of health care resources and the planning of preventive approaches. Epidemiological needs will also make special demands of a classification, the main requirement being for clear, unambiguous definitions. The classification formulated by the US National Diabetes Data Group (NDDG)1 and adopted in the Second Report of the World Health Organization Expert Committee on Diabetes Mellitus (WHO)2 (see abbreviated version, Table 1) goes a long way to meet the varying needs of these different user groups but falls short of perfection as is inevitable in any attempt to meet them all. It is the residual problems, mainly those for the epidemiologist, that are dealt with here.
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References
National Diabetes Data Group, Classification and diagnosis of diabetes and other categories of glucose intolerance, Diabetes 28: 139–157 (1979).
World Health Organisation Expert Committee, Second Report on Diabetes Mellitus, Tech. Rep. Series 646, WHO, Geneva (1980).
H. Keen, S. Tang Ng Fui, The definition and classification of diabetes mellitus, Clin. Endocrinol Metab. 11: 279–305 (1982).
K.M. West, Substantial differences in diagnostic criteria used by diabetes experts, Diabetes 24: 641–664 (1975).
H. Keen, R.J. Jarrett, P. McCartney, The ten-year follow-up of the Bedford Survey (1962–1972): glucose tolerance and diabetes, Diabetologia 22: 73–78 (1982).
T. Kadowaki, Y. Miyake, R. Hagura et al., Risk factors for worsening to diabetes in subjects with impaired glucose tolerance, Diabetologia 26: 44–49 (1984).
J.B. O’Sullivan, C.M. Mahan, Blood sugar levels, glycosuria and body weight related to development of diabetes mellitus, J. Am Med. Assoc. 194: 117–122 (1965).
R.J. Jarrett, H. Keen, J.H. Fuller, M. McCartney, Worsening to diabetes in men with impaired glucose tolerance (’borderline diabetes’), Diabetologia 16: 25–30 (1979).
A. Sasaki, T. Suzuki, N. Horiuchi, Development of diabetes in Japanese subjects with impaired glucose tolerance; a seven year follow-up study, Diabetologia 22: 154–157 (1982).
J.H. Fuller, M.J. Shipley, G. Rose, R.J. Jarrett, H. Keen, Coronary heart disease risk and impaired glucose tolerance: The Whitehall Study, Lancet 1: 1373–1376 (1980).
R.J. Jarrett, P. McCartney, H. Keen, The Bedford Survey: Ten year mortality rates in newly diagnosed diabetics, borderline diabetes and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics, Diabetologia 22: 79–84 (1982).
J.H. Fuller, M.J. Shipley, G. Rose, R.J. Jarrett, H. Keen, Mortality from coronary heart diease and stroke in relation to degree of glycaemia: The Whitehall Study, Br. Med. J. 287: 867870 (1983).
R. Stamler, and J. Stamler, Asymptomatic hyperglycaemia and coronary heart disease: a series of papers by the international collaborative group based on studies in fifteen populations, J. Chron Dis. 32: 683–837 (1979).
P.J. Savage, P.H. Bennett, P. Gorden, M. Miller, Insulin response to oral carbohydrate in true prediabetics and matched controls, Lancet 1: 300–302 (1975).
R.J. Jarrett, Reflections on gestational diabetes mellitus, Lancet 2: 1220–1222 (1981).
H. Keen, Glucose intolerance in pregnancy. Diabetologia 24: 460–461 (1983).
M.I. Harris, W.C. Hadden, W.C. Knowler, P.H. Bennett, “International criteria for the diagnosis of diabetes and impaired glucose tolerance” (In Press) (1984).
L. Jovanovic, C. Peterson, The clinical utility of glycosylated hemoglobin, Am. J. Med. 70: 331–338 (1981).
P.M. Hall, J.G.H. Cook, J. Sheldon, S.M. Rutherford, B.J. Gould, Glycosylated hemoglobins and glycosylated plasma proteins in the diagnosis of diabetes mellitus and impaired glucose tolerance, Diabetes Care 7: 147–150 (1984).
M. Modan, H. Halkin, A. Karasik, A. Lusky, Effectiveness of glycosylated haemoglobin, fasting plasma glucose and a single post-load plasma glucose level in population screening for glucose intolerance, Amer. J. Epidemiol 119: 431–444 (1984).
U. Di Mario, W.J. Irvine, D.Q. Borsey et al., Immune abnormalities in diabetic patients not requiring insulin at diagnosis, Diabetologia 25: 392–395 (1983).
S. Ng Tang Fui, H. Keen, R.J. Jarrett et al., Epidemiological study of prevalence of chlorpropamide alcohol flushing in insulin dependent diabetics, non-insulin dependent diabetics and non-diabetics, Br. Med. J. 287: 1509–1512 (1983).
R.B. Tattersall, R.H. Wilson, P. van der Minne, I. Deverill, K. Gelsthorpe, W.G. Reeves, Problems with the classification of Type I diabetes - a prospective study, Diabetic Med. (In Press) (1984).
S. Ng Tang Fui, H. Keen, R.J. Jarrett, W. Gossanin, P. Marsden, Test for chlorpropamide treatment in insulin-dependent and noninsulin-dependent diabetics, N. Eng. J. Med. 3009: 93–96 (1983).
P.S. Rotwein, J. Chirgwin, M. Province et al., Polymorphism in the 5’ flanking region of the human insulin gene: a genetic marker for non-insulin-dependent diabetes, N. Eng. J. Med. 308: 65–71 (1983).
H. Keen, J.K. Ekoe, The geography of diabetes, Brit Med. Bull 40: 359: 365 (1984).
E. Morrison, Diabetes mellitus–a third syndrome, Phasic insulin dependence (PID), Int. Diab. Fed. Bull 26: 6–8 (1981).
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Keen, H. (1985). Limitations and Problems of Diabetes Classification from an Epidemiological Point of View. In: Vranic, M., Hollenberg, C.H., Steiner, G. (eds) Comparison of Type I and Type II Diabetes. Advances in Experimental Medicine and Biology, vol 189. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1850-8_3
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DOI: https://doi.org/10.1007/978-1-4757-1850-8_3
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