Advertisement

Diagnostic Criteria and Classification of Diabetes

  • Rebekah GospinEmail author
  • James P. Leu
  • Joel Zonszein
Reference work entry

Abstract

Diabetes, a group of complex metabolic disorders, remains a major health problem in the twenty-first century. The unabated increasing rate of type 2 diabetes (T2DM) and obesity appears to be plateauing in the U.S.A. The incidence of the less common type 1 diabetes (T1DM) has also increased at a slower pace. Diabetes in children and adolescents, however, has accelerated and evolved into a heterogeneous condition that is more closely related to T2DM. The landscape of diabetes has changed dramatically in the past few decades. The knowledge gained from many large clinical trials and new drug development has led to a better understanding of the pathophysiology and treatment of each of the disease states. Diabetes remains characterized by elevated glycemic markers and distinctive complications. Better diagnosis and earlier treatment has resulted in fewer complications, but major challenges remain as the target guidelines are unmet in approximately half of the U.S. adult population, particularly among younger individuals in more susceptible ethnic and racial groups.

In this chapter we review the classification and diagnosis of the major types of diabetes. A well-established set of criteria is continuously revised to reflect current knowledge of the disease. Screening high-risk individuals has allowed for earlier diagnosis and patient-centered interventions to prevent complications. Fewer people now live with undiagnosed disease. While glycemic markers remain the gold standard for treatment and diagnosis, that advances in genetics and metabolomics will soon be used to better define and manage these conditions.

Due to the higher prevalence of obesity and diabetes in the young, diabetes in pregnancy is now found not only in those with established T1DM but also in those with T2DM. An increasing rate of women are diagnosed with diabetes during their pregnancy. Updated recommendations provide better methods and criteria for screening and diagnosis. We hope that this chapter helps to elucidate current and well-established criteria to screen high-risk individuals, allowing for both an earlier diagnosis as well as better patient-centered interventions to prevent future complications of this disease.

Keywords

Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Obesity Prediabetes Gestational Diabetes Mellitus 

References

  1. 1.
    Go AS, et al. Executive summary: heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143–52.CrossRefPubMedGoogle Scholar
  2. 2.
    American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–46.CrossRefPubMedCentralGoogle Scholar
  3. 3.
    American Diabetes Association. Standards of medical care in diabetes 2015. Diabetes Care. 2015;38 Suppl 1:S1–89.Google Scholar
  4. 4.
    Gregg EW, et al. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med. 2014;370(16):1514–23.CrossRefPubMedGoogle Scholar
  5. 5.
    Ali MK, et al. Achievement of goals in U.S. diabetes care, 1999–2010. N Engl J Med. 2013;368(17):1613–24.CrossRefPubMedGoogle Scholar
  6. 6.
    Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979;28(12):1039–57.Google Scholar
  7. 7.
    Danaei G, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Boyle JP, et al. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001;24(11):1936–40.CrossRefPubMedGoogle Scholar
  9. 9.
  10. 10.
    Geiss LS, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980–2012. JAMA. 2014;312(12):1218–26.CrossRefPubMedGoogle Scholar
  11. 11.
    Flegal KM, et al. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288(14):1723–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Ogden CL, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–14.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Menke A, et al. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988–2012. JAMA. 2015;314(10):1021–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Herman WH, et al. Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: a simulation of the results of the Anglo-Danish-Dutch study of intensive treatment in people with screen-detected diabetes in primary care (ADDITION-Europe). Diabetes Care. 2015;38(8):1449–55.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hsu WC, et al. BMI cut points to identify at-risk Asian Americans for type 2 diabetes screening. Diabetes Care. 2015;38(1):150–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Menke A, et al. The prevalence of type 1 diabetes in the United States. Epidemiology. 2013;24(5):773–4.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lawrence JM, et al. Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002–2009. Diabetes. 2014;63(11):3938–45.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Rodbard HW, et al. Trends in method of diagnosis of type 2 diabetes mellitus: results from SHIELD. Int J Endocrinol. 2009;2009:796206.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Group TS, et al. A clinical trial to maintain glycemic control in youth with type 2 diabetes. N Engl J Med. 2012;366(24):2247–56.CrossRefGoogle Scholar
  20. 20.
    Chiang JL, et al. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37(7):2034–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Naik RG, Brooks-Worrell BM, Palmer JP. Latent autoimmune diabetes in adults. J Clin Endocrinol Metab. 2009;94(12):4635–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Stenstrom G, et al. Latent autoimmune diabetes in adults: definition, prevalence, beta-cell function, and treatment. Diabetes. 2005;54 Suppl 2:S68–72.CrossRefPubMedGoogle Scholar
  23. 23.
    Banerji MA, Lebovitz HE. Insulin-sensitive and insulin-resistant variants in NIDDM. Diabetes. 1989;38(6):784–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Tuomi T, et al. The many faces of diabetes: a disease with increasing heterogeneity. Lancet. 2014;383(9922):1084–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Greeley SA, et al. Neonatal diabetes: an expanding list of genes allows for improved diagnosis and treatment. Curr Diab Rep. 2011;11(6):519–32.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Magliano D et al. Classification of diabetes mellitus and other categories of glucose intolerance. In: International textbook of diabetes mellitus. 4th ed. John Wiley & Sons Ltd Chichester, UK; 2015. p. 3–16.Google Scholar
  27. 27.
    Fajans SS, Bell GI. MODY: history, genetics, pathophysiology, and clinical decision making. Diabetes Care. 2011;34(8):1878–84.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Froguel P, et al. Familial hyperglycemia due to mutations in glucokinase. Definition of a subtype of diabetes mellitus. N Engl J Med. 1993;328(10):697–702.CrossRefPubMedGoogle Scholar
  29. 29.
    Gloyn AL, et al. Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabetes. N Engl J Med. 2004;350(18):1838–49.CrossRefPubMedGoogle Scholar
  30. 30.
    Pearson ER, et al. Switching from insulin to oral sulfonylureas in patients with diabetes due to Kir6.2 mutations. N Engl J Med. 2006;355(5):467–77.CrossRefPubMedGoogle Scholar
  31. 31.
    Donovan LE, Severin NE. Maternally inherited diabetes and deafness in a North American kindred: tips for making the diagnosis and review of unique management issues. J Clin Endocrinol Metab. 2006;91(12):4737–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Liu M, et al. INS-gene mutations: from genetics and beta cell biology to clinical disease. Mol Aspects Med. 2015;42:3–18.CrossRefPubMedGoogle Scholar
  33. 33.
    Elders MJ, et al. Endocrine-metabolic relationships in patients with leprechaunism. J Natl Med Assoc. 1982;74(12):1195–210.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Boucher J, Kleinridders A, Kahn CR. Insulin receptor signaling in normal and insulin-resistant states. Cold Spring Harb Perspect Biol. 2014; 6(1):1–23.Google Scholar
  35. 35.
    Taylor SI, et al. Mutations of the human insulin receptor gene. Trends Endocrinol Metab. 1990;1(3):134–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Bonnefond A, Froguel P. Rare and common genetic events in type 2 diabetes: what should biologists know? Cell Metab. 2015;21(3):357–68.CrossRefPubMedGoogle Scholar
  37. 37.
    Segre AV, et al. Pathways targeted by antidiabetes drugs are enriched for multiple genes associated with type 2 diabetes risk. Diabetes. 2015;64(4):1470–83.CrossRefPubMedGoogle Scholar
  38. 38.
    Hivert MF, et al. Updated genetic score based on 34 confirmed type 2 diabetes Loci is associated with diabetes incidence and regression to normoglycemia in the diabetes prevention program. Diabetes. 2011;60(4):1340–8.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Nilsson E, et al. Altered DNA methylation and differential expression of genes influencing metabolism and inflammation in adipose tissue from subjects with type 2 diabetes. Diabetes. 2014;63(9):2962–76.CrossRefPubMedGoogle Scholar
  40. 40.
    Barrett JC, et al. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes. Nat Genet. 2009;41(6):703–7.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Wang TJ, et al. Metabolite profiles and the risk of developing diabetes. Nat Med. 2011;17(4):448–53.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Walford GA, et al. Metabolite traits and genetic risk provide complementary information for the prediction of future type 2 diabetes. Diabetes Care. 2014;37(9):2508–14.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Moran A, et al. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care. 2010;33(12):2697–708.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Mohan V, et al. Fibrocalculous pancreatic diabetes. Long-term survival analysis. Diabetes Care. 1996;19(11):1274–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Kuroda Y, et al. Hyperinsulinemic hypoglycemia syndrome associated with mutations in the human insulin receptor gene: report of two cases. Endocr J. 2015;62(4):353–62.CrossRefPubMedGoogle Scholar
  46. 46.
    Gresa-Arribas N, et al. Antibodies to inhibitory synaptic proteins in neurological syndromes associated with glutamic acid decarboxylase autoimmunity. PLoS One. 2015;10(3):e0121364.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    First MR, et al. New-onset diabetes after transplantation (NODAT): an evaluation of definitions in clinical trials. Transplantation. 2013;96(1):58–64.CrossRefPubMedGoogle Scholar
  48. 48.
    Cosio FG, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int. 2005;67(6):2415–21.CrossRefPubMedGoogle Scholar
  49. 49.
    Sharif A, Baboolal K. Diagnostic application of the A(1c) assay in renal disease. J Am Soc Nephrol. 2010;21(3):383–5.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Genuth S, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Zhang X, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010;33(7):1665–73.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Ackermann RT, et al. Identifying adults at high risk for diabetes and cardiovascular disease using hemoglobin A1c National Health and Nutrition Examination Survey 2005–2006. Am J Prev Med. 2011;40(1):11–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Erickson SC, et al. New-onset treatment-dependent diabetes mellitus and hyperlipidemia associated with atypical antipsychotic use in older adults without schizophrenia or bipolar disorder. J Am Geriatr Soc. 2012;60(3):474–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Emerging Risk Factors Collaboration, et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA. 2014;311(12):1225–33.CrossRefGoogle Scholar
  55. 55.
    Harris MI, et al. Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 yr. Diabetes. 1987;36(4):523–34.CrossRefPubMedGoogle Scholar
  56. 56.
    Knowler WC, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMedGoogle Scholar
  57. 57.
    Engelgau MM, et al. The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care. 1995;18(7):1029–33.CrossRefPubMedGoogle Scholar
  58. 58.
    Langer O, et al. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol. 1994;170(4):1036–46. discussion 1046–7.CrossRefPubMedGoogle Scholar
  59. 59.
    Group HSCR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.CrossRefGoogle Scholar
  60. 60.
    International Association of Diabetes, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.CrossRefGoogle Scholar
  61. 61.
    Vandorsten JP, et al. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements. 2013;29(1):1–31.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Department of MedicineMontefiore Medical Center and Albert Einstein College of MedicineBronxUSA

Personalised recommendations