Chapter 3. Evidence-Based Definition and Classification: A Commentary

  1. R. Williams2,
  2. W. Herman3,
  3. A.-L. Kinmonth5 and
  4. N. J. Wareham4
  1. Steve O'Rahilly

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch3

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

O'Rahilly, S. (2002) Evidence-Based Definition and Classification: A Commentary, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch3

Editor Information

  1. 2

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 3

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 4

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 5

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. Department of Medicine and Clinical Biochemistry, Box 157, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582

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Keywords:

  • diagnosis;
  • definition;
  • metabolic abnormality;
  • organ dysfunction;
  • risk;
  • associated disease;
  • pathophysiology;
  • polygenic determinants;
  • gene-environment interaction

Summary

The classification and reclassification of disease has been an obsession of the healing professions since their earliest recorded history. To the practising clinician, the ability to classify a sub-type of diabetes is relevant, if it provides information regarding the likely natural history of the disease and or its response to therapy. To the diabetes researcher, accurate classification is essential for discovery of the aetiological factors underlying a particular type of diabetes. Type 2 diabetes is the least satisfactory of the current classications, representing the majority of people with diabetes worldwide. This reflects the fact that there are probably many aetiological and pathophysiological routes to developing a condition of sustained, survivable hyperglycaemia. Progress will depend on the definition of more specific types, with improved insight into the pathology and greater understanding of the genetics and the interaction of genetic susceptibility with environmental effects. For type 1 diabetes, the challenge of more accurate subclassification lies in the ability to identify at risk and presymptomatic individuals for more specific and earlier interventions.