Proposed New Classification: No More Type 1 or Type 2 Diabetes

I created this without realizing a post on this topic had already been created. If you want to add to the discussion, please do so in Proposal to Drop Type 1 and Type 2 Classification.


This post is mostly just a link to a rather brief and jargony article that stumbled into my path.
A New Proposed Classification of Diabetes: No More Type 1 or Type 2 Diabetes on the website

What I found most interesting is how unaware I appear to be of the many different mechanisms which may hide behind a diagnosis of “diabetes mellitus”. Toto, it looks like we left Kansas behind us quite a few years ago.

The basis of the new classification system is treatment of patients as individuals though currently most prescribers will initiate treatment based on a diagnosis instead of the person. Schwartz believes that diabetes is rooted to β-cell and because of this, classification of diabetes types should be based on causes of that damage so physicians will know how to go about treatment. This “β-cell centric” criterion recognizes that β-cell damage can be caused by inflammation, immune actions, gut biome, high fatty acids, high glucose levels, genetics and other causes; categorization founded on these sources can help cultivate an improved treatment strategy, as opposed to simply knocking down an individual’s glucose level.

I don’t really think this “new classification” is ever going to amount to anything other than possibly some discussions in the medical research. After all, my personal feeling is that one heck of a lot of the currently practicing MDs haven’t really gotten around to working well with the T1 & T2 classifications. If you tried to explain to them that there may be “a total of 11 interconnecting pathways that contribute to hyperglycemia”, I expect many will just “Harrumph!” you and walk away. :wink:


Any discussion about “reclassification” tends to become controversial quickly - I hope I don’t offend anyone with my comments, that is certainly not my intention. Every person deserves access to the treatment they need for their individual challenges. Unfortunately, at least in the US, in our current healthcare system, a lot is driven by the diagnosis code assigned by their physician. Any classification change can lead to errors, delays, or at best additional stress to get the correct coding to receive the necessary treatment. Still…

I don’t remember where or when, but I saw a similar (perhaps the same?) proposal some time back. At the time, the proposal was presented as a work in progress, since potential criteria for classification are many. The requirement is to find a balance between ease of use - to avoid healthcare provider confusion - and diagnostic/clinical requirements - to correctly qualify treatment options. The current article appears more developed.

As someone who has experienced some of what I call “Type 2 discrimination,” in regard to access to treatment options, I can see the value in a classification system that aims to minimize this. As a Type 2 dependent on insulin, I have had to fight a battle for nearly every aspect of my treatment. I have been told by medical professionals that a T2D cannot have hypoglycemia unawareness, will never get any benefit from using a pump, and shouldn’t have to test more than once or twice a day. I have been told to “just use less insulin” even if it means that my BG is high all the time - because using less insulin is more important. (I’m still trying to figure out what that last one even MEANS!) I was also told that all my “symptoms” have to be psychosomatic, since “T2s don’t have such symptoms.” Oh yes, I was told that many of my problems are because I “choose to use insulin.” Really? A needle-phobic person like me WANTS to use needles?

From the insurance side, I’ve been told that pumps and CGM are “unproven, experimental treatment” for my condition. I’ve gotten past that, for now, but expect the same battle in July with the annual formulary review, or if I have to change insurance providers. Thankfully, the insulin prescription at least made test strip limits higher than 2/day.

OK, maybe I encountered some idiotic so-called “healthcare professionals,” but a lot of my problem with at resulted from the oversimplification of the “Type 2” diagnosis. “Textbook medicine” doesn’t make it easy for doctors to provide the kind of individualized care that the multifaceted nature of Type 2 diabetes (and in its ways, of Type 1 as well) presents. I was able to skip through some of the potential quagmire initially because I have a smart, proactive PCP who monitored the initial treatment selections closely, making changes quickly until it became clear that insulin was the best option. (Ok, a bit of persistence on my part helped, too.) I may otherwise have spent months or longer on diet/exercise programs that wouldn’t work, medications that made me ill and who knows what else.

Type 2, insulin deficient with hypoglycemia unawareness. Am I at risk for DKA? I don’t know, and I sure don’t want to find out! I’ve had two endocrinologists tell me that I’m their “most difficult (or complicated) case.” I don’t see how that is so, though - I have no co-morbidities.

One last thing – When will someone make a commercial for a Type 2 diabetes treatment that includes only “patients” ho appear to be at a healthy weight, instead of parading one obese T2D after another!? :scream:

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We actually had a topic on this yesterday called “Proposal to Drop Type 1 and Type 2 Classification.” Is this topic different?

Yes. Is there a way to combine the two?

There is no administrative way to move posts and preserve the ownership etc. It is up to the commenters in this thread to report in the original thread.

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Bummer! :confused::slightly_frowning_face::frowning:️

I wish that whatever changes out my emotions would cease and desist!

Brian, I edited my post to add a link to your discussion. The most effective way that I can see to channel future posts to that thread is to lock this one. I suggest you do that.