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Lancet. 2014 Mar 22;383(9922):1084-94. doi: 10.1016/S0140-6736(13)62219-9. Epub 2013 Dec 3.

The many faces of diabetes: a disease with increasing heterogeneity.

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Department of Medicine, Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.
Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
Department of Endocrinology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Malmö, Sweden; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland. Electronic address:


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.

[Indexed for MEDLINE]

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