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© 2002 by the American Diabetes Association, Inc.
Committee Report |
Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus*the American Diabetes Association, Alexandria, Virginia. Originally approved 1997. Modified in 1999 based on the Proceedings of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus (Diabetes Care 21 [Suppl. 2]:B1–B167, 1998).
The current classification and diagnosis of diabetes used in the U.S. was developed by the National Diabetes Data Group (NDDG) and published in 1979 (1). The impetus for the classification and diagnosis scheme proposed then holds true today. That is,
the growth of knowledge regarding the etiology and pathogenesis of diabetes has led many individuals and groups in the diabetes community to express the need for a revision of the nomenclature, diagnostic criteria, and classification of diabetes. As a consequence, it was deemed essential to develop an appropriate, uniform terminology and a functional, working classification of diabetes that reflects the current knowledge about the disease. (1)It is now considered to be particularly important to move away from a system that appears to base the classification of the disease, in large part, on the type of pharmacological treatment used in its management toward a system based on disease etiology where possible.
An international Expert Committee, working under the sponsorship of the American Diabetes Association, was established in May 1995 to review the scientific literature since 1979 and to decide if changes to the classification and diagnosis of diabetes were warranted. The Committee met on multiple occasions and widely circulated a draft report of their findings and preliminary recommendations to the international diabetes community. Based on the numerous comments and suggestions received, including the opportunity to review unpublished data in detail, the Committee discussed and revised numerous drafts of a manuscript that culminated in this published document.
This report is divided into four sections: definition and description of diabetes, classification of the disease, diagnostic criteria, and testing for diabetes. The aim of this document is to define and describe diabetes as we know it today, present a classification scheme that reflects its etiology and/or pathogenesis, provide guidelines
DEFINITION AND DESCRIPTION OF DIABETES MELLITUS
CLASSIFICATION OF DIABETES MELLITUS AND OTHER CATEGORIES OF GLUCOSE REGULATION
Type 1 diabetes (ß-cell destruction, usually leading to absolute insulin deficiency)
Immune-mediated diabetes.
Idiopathic diabetes.
Type 2 diabetes (ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance)
Other specific types of diabetes
Genetic defects of the ß-cell.
Genetic defects in insulin action.
Diseases of the exocrine pancreas.
Endocrinopathies.
Drug- or chemical-induced diabetes.
Infections.
Uncommon forms of immune-mediated diabetes.
Other genetic syndromes sometimes associated with diabetes.
Gestational diabetes mellitus (GDM)
Testing for gestational diabetes.
Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)
DIAGNOSTIC CRITERIA FOR DIABETES MELLITUS
The new criteria
Rationale for the revised criteria for diagnosing diabetes
TESTING FOR DIABETES IN PRESUMABLY HEALTHY INDIVIDUALS
Acknowledgments
Footnotes
References
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