American Diabetes Association® Issues Expert Consensus on Differentiation of Diabetes


Michelle Kirkwood

Arlington, Virginia
December 15, 2016

Report outlines approaches to achieve personalized diabetes care

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), will be published in Diabetes online at 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 will be published online at on Dec. 15, 2016 and in an upcoming print issue of Diabetes.

About 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.

About the American Diabetes Association

Nearly half of American adults have diabetes or prediabetes; more than 30 million adults and children have diabetes; and every 21 seconds, another individual is diagnosed with diabetes in the U.S. Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes. In addition, the ADA supports people living with diabetes, those at risk of developing diabetes, and the health care professionals who serve them through information and programs that can improve health outcomes and quality of life. For more information, please call the ADA at 1-800-DIABETES (1-800-342-2383) or visit Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)