title: The many faces of diabetes: a disease with increasing heterogeneity.
abstract: Diabetes is a much more heterogeneous disease than the present subdivision into types 1 and 2 assumes; type 1 and type 2 diabetes probably represent extremes on a range of diabetic disorders. Both type 1 and type 2 diabetes seem to result from a collision between genes and environment. Although genetic predisposition establishes susceptibility, rapid changes in the environment (ie, lifestyle factors) are the most probable explanation for the increase in incidence of both forms of diabetes. Many patients have genetic predispositions to both forms of diabetes, resulting in hybrid forms of diabetes (eg, latent autoimmune diabetes in adults). Obesity is a strong modifier of diabetes risk, and can account for not only a large proportion of the epidemic of type 2 diabetes in Asia but also the ever-increasing number of adolescents with type 2 diabetes. With improved characterisation of patients with diabetes, the range of diabetic subgroups will become even more diverse in the future.
authors: Department of Medicine, Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
authors: Tiinamaija
authors: T
authors: Tuomi
authors: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors: Nicola
authors: N
authors: Santoro
authors: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors: Sonia
authors: S
authors: Caprio
authors: Department of Endocrinology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Mengyin
authors: M
authors: Cai
authors: Department of Endocrinology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors: Jianping
authors: J
authors: Weng
authors: Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Malmö, Sweden; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland. Electronic address: leif.groop@med.lu.se.
authors: Leif
authors: L
authors: Groop
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D003922:Diabetes Mellitus, Type 1 / Q000145:classification / Q000453:epidemiology / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000145:classification / Q000453:epidemiology / Q000378:metabolism*; D059647:Gene-Environment Interaction; D020022:Genetic Predisposition to Disease; D005947:Glucose / Q000378:metabolism*; D018149:Glucose Intolerance / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000172:deficiency*; D007333:Insulin Resistance; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism*
chemical_list: D007328:Insulin; D005947:Glucose