SPECIAL REPORT
Classification of Genetic Diabetes Mellitus
A classification of genetic diabetes mellitus based on
abnormalities of carbohydrate metabolism is given be-
low. Progression or regression from one stage to the
next may never occur, may proceed slowly over many
years or may be very rapid. This classification does not
consider the presence or absence of vascular disease, for
patients with minimal glucose intolerance or even nor-
mal tolerance may have angiopathy.
1. Overt Diabetes Mellitus
This is frank diabetes, either of the ketosis-prone
or ketosis-resistant type. Fasting hyperglycemia is
present. Symptoms of hyperglycemia and glucosuria
may be present. A glucose tolerance test is not re-
quired for diagnosis.
2. Chemical or Latent Diabetes
This is asymptomatic diabetes. The fasting blood
glucose level may be elevated but is usually normal
and the postprandial level is frequently elevated.
Oral or intravenous glucose tolerance tests per-
formed in the absence of "stress" give results in the
ranges accepted for diabetes.
3. Suspected Diabetes Mellitus {Including "Stress"
Hyperglycemia)
Persons who have temporary carbohydrate in-
tolerance in certain physiological or pathological
situations should be suspected of having diabetes
mellitus, particularly when there is a family his-
tory of diabetes. Symptoms due to severe hyper-
glycemia occurring during periods of "stress" should
be regarded as representing overt diabetes until
proved otherwise. Asymptomatic or symptomatic
derangement of carbohydrate tolerance should be re-
evaluated after total recovery from the "stress." In
particular, impaired carbohydrate tolerance in the
following situations requires long-term evaluation:
A. Pregnancy. The term "gestational diabetes" in-
dicates the presence of abnormal glucose toler-
ance which reverts to normal following delivery.
In these individuals follow-up studies have re-
vealed a high risk of development of diabetes.
(Diabetes should also be suspected in a woman
whose obstetrical history includes large babies,
540
unexplained abortions, fetal deaths, neonatal
deaths, or hydramnios.)
B. Obesity with abnormal glucose tolerance which-
returns promptly to normal with moderate
weight loss.
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C. Infections, trauma, vascular accidents, burns, im-
paired nutrition, and severe emotional disturb-
ances.
D. Treatment with pharmacologic agents, such as
corticosteroids or thiazides.
E. Endocrinopathies such as acromegaly, Cushing's
syndrome, thyrotoxicosis, and pheochromocytoma.
(Diabetes must also be suspected in elderly subjects
without symptoms and signs of the disease but with
a glucose tolerance test which in younger indi-
viduals would be considered abnormal.)
4. Prediabetes
Prediabetes is a term applied to the period of
time prior to the onset of identifiable diabetes mel-
litus (overt, chemical or latent). This is a con-
ceptual term identifying the interval between fer-
tilization of the ovum and the demonstration of im-
paired glucose tolerance in an individual predis-
posed to diabetes on genetic grounds but presently
exhibiting a normal glucose tolerance. It cannot be
diagnosed with certainty in the current state of our
knowledge except in the nondiabetic identical twin
of a diabetic patient and possibly in the offspring
of two diabetic parents.
COMMITTEE ON PROFESSIONAL EDUCATION
George J. Hamwi, M.D.,* Chairman
Stefan S. Fajans, M.D.,t Vice Chairman
George F. Cahill, Jr., M.D.
Wayne V. Greenberg, M.D.
Robert C. Hardin, M.D.
Edgar A. Haunz, M.D.
David M. Kipnis, M.D.
Roger H. Unger, M.D.
Kelly M. West, M.D.
* Deceased February 1967
fAppointed Acting Chairman March 1967
DIABETES, VOL. 16, NO. 7