Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group
Abstract
:1. Introduction
2. Update on (Type 2) Diabetes Classification
3. Update on (Type 2) Diabetes Staging
4. Proposal of Classification and Therapeutic Algorithm
- Diabetes syndrome with severe insulin deficiency: Early detection and treatment of insulin deficiency are critical to avoid microvascular complications [37]. The use of continuous glucose monitoring is strongly recommended to guide insulin requirements by providing both real-time and predictive glycemic data [38].
- Diabetes syndrome associated with severe insulin resistance: Early and intensive treatment is crucial for delaying progression. Abnormal adiposity distribution and function are usually accompanied by inflammation, dyslipidemia, hypertension, and fatty liver disease [39]. Thus, this subgroup is likely to benefit from enhanced monitoring and support and the early use of diabetes/disease-modifying drugs (DMDs), such as sodium glucose co-transporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA), which are prognosis-changing agents [40].
- Mild diabetes associated with obesity: This phenotype is characterized by subclinical hyperinsulinism. Treatment of this subset of patients primarily involves weight loss, with a potential role for GLP-1 RA in enhancing remission of the disease beyond healthy habits [41].
- Mild age-related diabetes: This subgroup includes older people who have the most benign course of the disease, mainly caused by age-related impaired beta-cell function. In fact, when adjusted for current age, older age at T2D diagnosis is associated with a reduced risk of mortality and microvascular and macrovascular complications [42]. Conservative management, including medical monitoring and pharmacological treatment, is advisable.
5. Methods and Values Recommended for the Clinical Classification of Diabetes
- Autoimmunity
- Age
- Insulin secretion
- C-peptide levels < 0.3 nmol/L: a multiple-insulin regimen is recommended as for T1D.
- C-peptide values ≥ 0.3 and <0.7 nmol/L: non-insulin agents plus basal insulin should be considered.
- C-peptide values > 0.7 nmol/L: non-insulin agents according to the specific phenotype are recommended.
- Insulin resistance
- Adiposity
6. Limitations, Gaps, and Further Research
7. Conclusions and Call to Action
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
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Gómez-Peralta, F.; Pinés-Corrales, P.J.; Santos, E.; Cuesta, M.; González-Albarrán, O.; Azriel, S.; on behalf the AGORA Diabetes Collaborative Group. Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group. J. Clin. Med. 2024, 13, 4839. https://doi.org/10.3390/jcm13164839
Gómez-Peralta F, Pinés-Corrales PJ, Santos E, Cuesta M, González-Albarrán O, Azriel S, on behalf the AGORA Diabetes Collaborative Group. Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group. Journal of Clinical Medicine. 2024; 13(16):4839. https://doi.org/10.3390/jcm13164839
Chicago/Turabian StyleGómez-Peralta, Fernando, Pedro J. Pinés-Corrales, Estefanía Santos, Martín Cuesta, Olga González-Albarrán, Sharona Azriel, and on behalf the AGORA Diabetes Collaborative Group. 2024. "Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group" Journal of Clinical Medicine 13, no. 16: 4839. https://doi.org/10.3390/jcm13164839