Type 2 diabetes is a syndrome defined by hyperglycaemia that is the result of various degrees of pancreatic β-cell failure and reduced insulin sensitivity. Despite the fact that diabetes can be caused by multiple metabolic dysfunctions, the majority of patients are defined as having either type 1 or type 2 diabetes. Recently, Ahlqvist and colleagues proposed a new way to classify patients with adult-onset diabetes, taking the heterogenous metabolic phenotype of the disease into account. This new classification system could be useful for a more personalized treatment based on the underlying metabolic disruption of the disease, although so far no prospective intervention studies have generated data to support such a claim.
In this review, we first provide a short overview of the phenotype and pathogenesis of type 2 diabetes, and discuss the current and new classification system. Further, we aim to review the effects of different antidiabetic medication classes on insulin sensitivity and β-cell function and discuss future treatment strategies based on the subgroups proposed by Ahlqvist et al. CONCLUSIONS: The proposed novel subgroups of type 2 diabetes provide an interesting concept that could lead to a better understanding of the pathophysiology of the broad group of type 2 diabetes paving the way for personalized treatment choices based on understanding the root cause of the disease. We conclude that all novel subgroups of adult-onset diabetes would benefit from antidiabetic medication that take into account the main pathophysiology of the disease and thereby prevent of end-organ damage. However, we are just in the beginning of personalized treatment of type 2 diabetes and studies to investigate effects of current and novel drugs in subgroups with different metabolic phenotypes is needed in order to develop personalized treatment of the syndrome.

Copyright © 2020 The Author(s). Published by Elsevier GmbH.. All rights reserved.