Stanley Schwartz
Emeritus Associate Professor of Medicine
School: Perelman School of Medicine
General Topic Areas: Diabetes, Prediabetes
Sample Talk Topics or Titles:
- All You Want to Know About Diabetes, but Were Afraid to Ask Your Doctor
This session is a Q & A driven by audience questions about anything related to diabetes. - The Time is Right for a New Classification of Diabetes
The current classification system presents challenges to the diagnosis and treatment of patients with diabetes mellitus (DM), in part due to its conflicting and confounding definitions of type 1 DM, type 2 DM, and latent autoimmune diabetes of adults (LADA). The current schema also lacks a foundation that readily incorporates advances in our understanding of the disease and its treatment. For appropriate and coherent therapy, we propose an alternate classification system. The b-cell–centric classification of DM is a new approach that obviates the inherent and unintended confusions of the current system. The b-cell–centric model pre- supposes that all DM originates from a final common denominatordthe abnormal pancreatic b-cell. It recognizes that interactions between genetically predisposed b-cells with a number of factors, including insulin resistance (IR), susceptibility to environmental influences, and immune dysregulation/inflammation, lead to the range of hyperglycemic phenotypes within the spectrum of DM. Individually or in concert, and often self-perpetuating, these factors contribute to b-cell stress, dys- function, or loss through at least 11 distinct pathways. Available, yet underutilized, treatments provide rational choices for personalized therapies that target the in- dividual mediating pathways of hyperglycemia at work in any given patient, with- out the risk of drug-related hypoglycemia or weight gain or imposing further burden on the b-cells. This talk issues an urgent call for the review of the current DM classification system toward the consensus on a new, more useful system. - The Diabetes Syndrome
The four basic pathophysiologic mechanisms which damage the β-cell within diabetes (ie, genetic and epigenetic changes, inflammation, an abnormal environment, and insulin resistance [IR]) also contribute to cell and tissue damage and elevate the risk of developing all typical diabetes-related complications. Genetic susceptibility to damage from abnormal external and internal environmental factors has been described including inflammation and IR. All these mechanisms can promote epigenetic changes, and in total, these pathophysiologic mechanisms interact and react with each other to cause damage to cells and tissues ultimately leading to disease. Importantly, these pathophysiologic mechanisms also serve to link other common conditions including cancer, dementia, psoriasis, atherosclerotic cardiovascular disease (ASCVD), nonalcoholic fatty liver disease (NAFLD), and nonalcoholic steatohepatitis (NASH). The “Diabetes Syndrome”, an overarching group of interrelated conditions linked by these overlapping mechanisms, can be viewed as a conceptual framework that can facilitate understanding of the interrelationships of superficially disparate conditions. Recognizing the association of the conditions within the Diabetes Syndrome due to common pathophysiologies has the potential to provide both benefit to the patient (eg, prevention, early detection, precision medicine) and to the advancement of medicine (eg, driving education, research, and dynamic decision-based medical practice).
