Classification of DM

There are four major categories of diabetes: type 1, type 2, gestational, and “other.”

 Type 1 Diabetes

Type 1 diabetes, or T1DM, is characterized by insufficient insulin secretion. Type 1

diabetes usually results from autoimmune destruction of the beta cells in the pancreas.
People with type 1 diabetes need exogenous (sources outside the body) insulin to
survive. People with type 1 diabetes represent only 5% to 10% of all people with diabetes
(Maitra, 2009). People with type 1 diabetes cannot make sufficient insulin to survive.

In the past, type 1 diabetes was called “insulin-dependent diabetes.” The ADA changed
the nomenclature as more patients with type 2 became dependent on insulin for sugar
regulation, which was confusing to both patients and healthcare providers; so the name
reverted back to “type 1.”

Type 1 diabetes has also been called juvenile diabetes because it typically appears in

children and young adults. Type 1 diabetes can present as an acute illness; however, the
destruction of the beta cells may have been occurring for weeks prior to the acute
symptoms.

 Type 2 Diabetes

Type 2 diabetes, or T2DM, is the most common form of diabetes, and is characterized by
insulin resistance, or sluggish response of insulin after food consumption. Type 2 diabetes
represents 90% of all people with diabetes. Insulin resistance is the reduced response of
skeletal muscle cells to take up insulin. Type 2 diabetes is characterized by two main
defects: insulin resistance, in which many cells in the body become less responsive to
insulin; and beta cell deterioration, which leads to sluggish production of insulin by the
pancreas.

Even before the disease shows clinical signs and symptoms, mildly elevated blood
glucose (BG) levels can be detected in tests. This stage of the disease is
called prediabetes. The progression of type 2 diabetes is gradual. Over the years, the
individual’s prediabetes worsens, especially if the person is overweight and inactive.
 Type 2 diabetes was once called “adult-onset diabetes” because the disease develops
slowly and typically appears in older adults. Ninety to ninety-five percent of all present
cases of diabetes are type 2; however, the age at which the condition is being diagnosed
continues to lower, even including obese children. In the United States, type 2 diabetes is
found in less than 2.5% of people aged 20 to 39 years, 10.5 % of people aged 40 to 59
years, and 23% of people 60 years of age or older.

Type 2 diabetes mellitus is a progressive disease that inevitably worsens over time, even
with appropriate management and maintenance of the therapeutic regimen. For many
individuals, up to 50% of beta cell function is lost by the time the diagnosis is made. An
additional 3% to 5% may be lost in each subsequent year (UK Prospective Diabetes Study
Group, 1998). People with type 2 diabetes also have a progressively reduced secretion of
insulin. Initially, many people with type 2 diabetes can live without additional insulin;
however, the disease worsens, and many people with type 2 diabetes eventually need
insulin because of the duration of the disease and pancreatic fatigue.

Given the rapid increase in the number of people with this condition, and the increasingly
younger age when the disease is diagnosed, healthcare providers need to be skilled in
detection, management, education, and prevention strategies in order to decrease the
overall burden on health and finances to patients and their families.

 Gestational Diabetes

Gestational diabetes mellitus (GDM) is diabetes that develops for the first time during
pregnancy and is seen as persistent hyperglycemia. Due to the overall stress of the
pregnancy, and with additional risk factors similar to those of type 2 diabetes, such as
obesity, sedentary lifestyle, high-fat diet, age, ethnicity, and genetic predispositions,
almost 21% of all pregnancies may develop hyperglycemia.

Recommendations for GDM include:

 Screen for undiagnosed T2DM at the first prenatal visit in those with risk factors,
using standard criteria.
 In pregnant women not previously known to have diabetes, screen for GDM at 24 to
28 weeks’ gestation with a 75-g, 2h OGTT using the following stricter diagnostic cutoff
points:

o Fasting >92mg/dL in the morning after an overnight fast of at least 8 hours

o 1 hour >180mg/dL

o 2hour >153mg/dL
 If undiagnosed T2DM is suspected to have existed at the time of pregnancy, rescreen
at 6 to 12 weeks’ postpartum, using standard criteria.

 Women diagnosed with GDM should have lifelong screening for the development of
T2DM or prediabetes at least every 3 years (ADA, 2012).

 Other Types of Diabetes

Types of diabetes that fall into the “other” class of diabetes mellitus include MODY,
LADA, endocrinopathies, and impaired fasting glucose (IFG).

MODY is a genetic mutation in an autosomal dominant gene that affects insulin

production. Individuals with this diagnosis are generally children less than age 25 with a
family history of diabetes for generations. These children still produce some insulin and
are clinically closer to a type 2. They may or may not require insulin.

LADA presents in young adults in their twenties and can be confused as type 2 because
of age; however, they do not produce any insulin and are clinically similar to type 1,
requiring insulin. They have often been labeled as “diabetes 1.5” because they are
clinically between type 1 and type 2.

Endocrinopathies may include polycystic ovarian syndrome, pancreatic cancer or

tumors, and other hormonal disruptions in insulin production. Impaired fasting glucose
presents as an FBG higher than 100 mg/dl but less than 126 mg/dl, so it does not qualify
as full diabetes mellitus.