[New diagnostic and classification system in diabetic syndrome]

Diabetes mellitus is a heterogeneous disorder. Evidence for heterogeneity is based on measuring endogenous insulin level since some forty years ago. Insulin is lacking at the time of diagnosis in most patients, whose disease started rapidly, with classical symptoms, and who are mainly children, adolescents or young adults. In the majority of middle-aged, obese diabetics, insulin levels are frequently high at diagnosis. Since insulin measuring from sera became a routine laboratory test these two main types were nominated as insulin-dependent, and insulin non-dependent types (IDDM and NIDDM). The aim of the recent classification was, that different diabetic subgroups should be based on etiologic evidence. (Previous classification was based mainly due to the current therapy!). To avoid confusing nominations, the recent classification recommended to abandon the acronyms, IDDM and NIDDM, and only type-1 and type-2 should be used In the third subgroup-other diabetic groups--there are selected many disorders, whose etiology is mostly clear. As fourth subgroup gestational diabetes preserved its previous place. There are some differential-diagnostic problems in between type-1 and type-2 subgroups, especially between lean body weight type-2 and-the newly discovered latent-onset diabetes in adults (LADA). Diagnostic criteria of diabetes and prediabetic states are being changed according to epidemiological data, because type-2 patients die frequently from cardio-cerebrovascular fatal disorders, and elevated blood sugar values-especially postprandially-contribute to it. Thresholds of blood sugar values for diagnosing diabetes are therefore decreasing, and a new category: impaired fasting glucose (IFG, blood sugar: 6, 1-7.0 mmol/l) was introduced. Impaired glucose tolerance (IGT) remained as prediabetic state. IGT + IFG are nominated as impaired glucoregulation. These two categories cover different populations. Oral glucose loading test in most problematic cases should be carried out. The clinical importance of postprandial hyperglycaemia (postprandial state) is discussed. As a new clinical concept, the Metabolic Syndrome seems to replace type-2 diabetes in the majority of these patients, even in the impaired glucose tolerance (IGT) state. Diabetics, carrying the features of this syndrome need holistic care.