[Phenotypic Classification of Diabetes: A Personalized Approach for Pharmaceutical Practice].

Abstract

Introduction: Diabetes mellitus (DM) is a heterogeneous metabolic disease with multiple pathophysiological mechanisms. The traditional classification into type 1 diabetes (T1D) and type 2 diabetes (T2D) does not fully capture the diversity of clinical and metabolic profiles among patients. Recently, Ahlqvist et al. proposed a model based on five phenotypic subtypes, enabling a more precise stratification of the disease and a personalized therapeutic approach.

Methods: Through cluster analysis in cohorts of diabetic patients, five subgroups were identified: Severe Autoimmune Diabetes (SAID), Severe Insulin Deficient Diabetes (SIDD), Severe Insulin Resistant Diabetes (SIRD), Mild Obesity-related Diabetes (MOD), and Mild Age-related Diabetes (MARD). These phenotypes differ in pathophysiology, disease progression, and treatment response.

Results and discussion: Phenotypic stratification allows better prediction of microvascular and macrovascular complications, optimizes pharmacotherapy, and enhances personalized interventions. In community pharmacy, this classification could improve subtype identification, facilitate more precise therapeutic recommendations, and promote treatment adherence. However, its implementation faces challenges, such as limited access to key biomarkers.

Conclusions: The phenotypic classification of DM represents a step toward personalized medicine. As key healthcare professionals in chronic disease management, community pharmacists can play a crucial role in its application, improving patient education and therapeutic monitoring to enhance clinical outcomes.