Modern concepts of type 2 diabetes mellitus phenotypes

In the context of the rapid increase in the prevalence of type 2 diabetes mellitus, the study of the phenotypic heterogeneity of the disease, caused by the variability of pathophysiological processes, the impact of environmental factors and individual genetic predisposition, is of particular importance. The traditional division into diabetes mellitus types 1 and 2 does not reflect the entire complexity of the pathogenesis and the diversity of clinical subtypes of type 2 diabetes mellitus. Modern studies reveal stable subgroups of patients with different clinical trajectories of disease development, which in the future will require a revision of diagnostic and therapeutic approaches. This review article analyzes studies devoted to the stratification of patients with type 2 diabetes mellitus. The key features of the most reproducible phenotypes, including severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe autoimmune diabetes (SAID), are disclosed, their pathophysiological characteristics, clinical features, therapeutic strategies, and approaches to the prevention of diabetic complications in various subgroups are given. Independent cohort studies have confirmed stable associations of the identified phenotypes with key clinical outcomes, including the degree of glycemic control, the incidence of microvascular and macrovascular complications, and mortality rates, which can be used in the future to develop personalized patient management strategies. However, further studies are required to validate and optimize the methods for subclassifying type 2 diabetes mellitus for the justified implementation of new treatment and diagnostic algorithms in everyday clinical practice.

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