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Diabetes mellitus classification Maraschin Jde F; Murussi N; Witter V; Silveiro SPArq Bras Cardiol 2010[Aug]; 95 (2): e40-6The right classification for diabetes mellitus (DM) allows a more adequate treatment and comprises four categories: type 1 DM, type 2 DM, other types, and gestational diabetes. In some cases, there might be a superposition of situations, especially with regard to the DM that initiates in the young adult or is initially presented with diabetic ketoacidosis intermediately to type 1 and 2 DM. Thus, additions to the classic classification system have been proposed as assessing the presence of autoimmunity (antibody) and b cell function (C-peptide) to precisely define the subtypes. The aim of this literature review was to analyze these diagnostic indexes; performance in the DM classification and to describe subtypes with details. The antibodies against pancreas confirm autoimmunity, and the antibody against insulin is more accurate before 5 years old, while the anti-glutamic acid decarboxylase is more accurate after 20 years old, a test which remains positive for a longer period. The measurement of C-peptide evaluates the pancreatic insulin reserve, and the most largely used methods of stimulation are the measurement after meals or after intravenous glucagon. C-peptide values < 1.5 ng/ml define a patient with absent pancreatic function and, above this value, patients with preserved function. When the presence of antibodies (A+) directed to the pancreas is combined to its insulin secretion capability (beta+), it is possible to subdivide DM;s classification in type 1A (A+beta-) and 1B (A+beta-); and type 2A (A+beta+) and 2B (A-beta+), which allows a more precise classification and treatment besides opening horizons for the understanding of DM pathogenesis.|*Autoimmunity/immunology[MESH]|Autoantibodies[MESH]|C-Peptide/blood[MESH]|Diabetes Mellitus/*classification[MESH]|Glutamate Decarboxylase/*immunology[MESH]|Humans[MESH] |
