Classification
Developed in cooperation with:
AACE Task Force for Developing a Diabetes Comprehensive Care Plan
Chairpersons:
Yehuda Handelsman, MD, FACP, FACE, FNLA
Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU
Lawrence Blonde, MD, FACP, FACE
George Grunberger, MD, FACP, FACE
Task Force Members:
Zachary T. Bloomgarden, MD, FACE
George A. Bray, MD, MACP, MACE
Samuel Dagogo-Jack, MD, FACE
Jaime A. Davidson, MD, FACP, MACE
Daniel Einhorn, MD, FACP, FACE
Om Ganda, MD, FACE
Alan J. Garber, MD, PhD, FACE
Irl B. Hirsch, MD
Edward S. Horton, MD, FACE
Faramarz Ismail-Beigi, MD, PhD
Paul S. Jellinger, MD, MACE
Kenneth L. Jones, MD
Lois Jovanovič, MD, MACE
Harold Lebovitz, MD, FACE
Philip Levy, MD, MACE
Etie S. Moghissi, MD, FACP, FACE
Eric A. Orzeck, MD, FACP, FACE
Aaron I. Vinik, MD, PhD, FACP, MACP
Kathleen L. Wyne, MD, PhD, FACE
ÎÎDiabetes mellitus (DM) represents a group of heterogeneous
metabolic disorders that develop when insulin secretion is insufficient
to maintain normal plasma glucose levels.
ÎÎType 2 DM (T2DM) is the most common form of DM, accounting for
more than 90% of cases. It is typically identified in patients older
than 30 years who are overweight or obese and/or have a positive
family history but do not have autoantibodies characteristic of type 1
DM (T1DM).
>> Most persons with T2DM have evidence of insulin resistance (such as high
triglycerides or low high-density lipoprotein cholesterol [HDL-C]) (A-1).
ÎÎT1DM is usually characterized by absolute insulin deficiency and
may be confirmed by the presence of autoantibodies to glutamic acid
decarboxylase, pancreatic islet β -cells (tyrosine phosphatase IA-2),
and/or insulin (A-1).
ÎÎGestational DM (GDM) is a condition in which women without previously
diagnosed DM exhibit elevated plasma glucose levels (C-3).
ÎÎThe very rare Monogenic T1DM (formerly maturity-onset diabetes of
the young) occurs in obese children and adolescents. A careful family
history, levels of insulin and C-peptide and the presence or absence of
immune markers may be useful in making this diagnosis (A-1).
>> Evaluation for monogenic DM is recommended for any child with an atypical
presentation, course, or response to therapy. Diagnostic likelihood is strengthened
by a family history over 3 generations suggesting autosomal dominant inheritance.
This type of DM can occur in the child before appearing in the parent or other
relatives (A-1).
