Diabetes Classification Beyond Stamp Collecting

Humans appear to have a powerful instinct to classify. In part this may spring from a purely intellectual and aesthetic requirement to create some sort of order from the bewildering chaos of observable natural phenomena. This inbuilt taxonomic imperative is likely, however, to have more utilitarian roots. To be able to manipulate the natural world to improves one's comfort and/or survival, one needs to understand its nature. The classification of natural phenomena into related groups is an essential first step towards this comprehension. Given the powerful threat represented by illness, it is not surprising that the classification and reclassification of disease has been a continued obsession of the healing professions since their earliest recorded history. In Chapter 2, Max de Courten provides a balanced and thorough account of how we have reached the currently accepted glycaemic criteria for the diagnosis of diabetes mellitus, and its classification into sub-types. In this short commentary I will concentrate entirely on the latter concept. In fact, I believe that the two terms italicised above are, in essence, tautologous. I would argue that the term definition is more appropriate for what is in essence a committee's pragmatic choice of a point on a glycaemic continuum, and that we should reserve the term diagnosis for occasions when we have more insight into the nature of a particular disease process.

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