Diabetes Management Based on the Phenotype and Stage of the Disease: An Expert Proposal from the AGORA Diabetes Collaborative Group

Abstract

Diabetes is a complex and rapidly growing disease with heterogeneous clinical presentations. Recent advances in molecular and genetic technologies have led to the identification of various subtypes of diabetes. These advancements offer the potential for a more precise, individualized approach to treatment, known as precision medicine. Recognizing high-risk phenotypes and intervening early and intensively is crucial. A staging system for type 1 diabetes has been proposed and accepted globally. In this article, we will explore the different methods for categorizing and classifying type 2 diabetes (T2D) based on clinical characteristics, progression patterns, risk of complications, and the use of molecular techniques for patient grouping. We, as a team of experts, will also present an easy-to-follow treatment plan and guidance for non-specialists, particularly primary care physicians, that integrates the classification and staging of diabetes. This will help ensure that the most suitable therapy is applied to the different types of T2D at each stage of the disease's progression.

Keywords: diabetes; diabetes complications; diabetes/disease-modifying drugs; insulin deficiency; insulin resistance; precision medicine; staging.

Figure 1

Therapeutic algorithm according to the clinical phenotype and disease stage. Abbreviations: BP, blood pressure; Bx, bariatric; CGM, continuous glucose monitoring; Clin. comp., clinical complications; CVD, cardiovascular diseases; DL, dyslipidemia; DMD, diabetes-modifying drug; IGT, impaired glucose tolerance; IFG, impaired fasting glucose; HBP, high blood pressure; ISCI, continuous insulin infusion; LDL-c, low-density lipoprotein cholesterol; LSM, lifestyle modification; Metf, metformin; Pio, pioglitazone.