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April 1977

Genetic, Acquired, and Related Factors in the Etiology of Diabetes Mellitus

Author Affiliations

From the E. P. Joslin Research Laboratory, Department of Medicine, Peter Bent Brigham Hospital, Harvard Medical School; and the Joslin Clinic and New England Deaconess Hospital, Boston.

Arch Intern Med. 1977;137(4):461-469. doi:10.1001/archinte.1977.03630160031010

Diabetes mellitus is not a single disease entity, but a heterogenous group of disorders with a striking diversity of etiopathogenetic mechanisms as well as clinical manifestations. Lack of a known genetic marker for the disease(s) and variable influences of environmental factors on the expression of a putative diabetic genome have resulted in considerable debate over its etiology.

Over the past few years, systematic epidemiologic studies, along with knowledge gained from a close association of certain human-leukocyte-antigens with the diabetic diathesis and possible role of host-immune factors, and gene-virus interaction have led to considerable advancement in the understanding of the disease-complex.

Pending the availability of definite genetic marker(s), we propose a new, tentative classification based on the etiologic mechanisms. We also suggest that the term "prediabetes" be abandoned as a prospective entity, since as presently employed, this connotation carries a risk probability no different than the terms like prehypertension or precoronary thrombosis.

(Arch Intern Med 137:461-469, 1977)

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