The current classification of diabetes, based on hyperglycaemia, islet-directed antibodies and some insufficiently defined clinical features, does not reflect differences in aetiological mechanisms and in the clinical course of people with diabetes. This review discusses evidence from recent studies addressing the complexity of diabetes by proposing novel subgroups (subtypes) of diabetes. The most widely replicated and validated approach identified, in addition to severe autoimmune diabetes, four subgroups designated severe insulin-deficient diabetes, severe insulin-resistant diabetes, mild obesity-related diabetes and mild age-related diabetes subgroups. These subgroups display distinct patterns of clinical features, disease progression and onset of comorbidities and complications, with severe insulin-resistant diabetes showing the highest risk for cardiovascular, kidney and fatty liver diseases. While it has been suggested that people in these subgroups would benefit from stratified treatments, RCTs are required to assess the clinical utility of any reclassification effort. Several methodological and practical issues also need further study: the statistical approach used to define subgroups and derive recommendations for diabetes care; the stability of subgroups over time; the optimal dataset (e.g. phenotypic vs genotypic) for reclassification; the transethnic generalisability of findings; and the applicability in clinical routine care. Despite these open questions, the concept of a new classification of diabetes has already allowed researchers to gain more insight into the colourful picture of diabetes and has stimulated progress in this field so that precision diabetology may become reality in the future.

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一种新的糖尿病类型学：从发病机制到治疗的精准糖尿病学

目前的糖尿病分类基于高血糖、胰岛导向抗体和一些未充分定义的临床特征，并未反映糖尿病患者病因机制和临床病程的差异。本综述通过提出新的糖尿病亚组（亚型）来讨论最近研究解决糖尿病复杂性的证据。除了严重的自身免疫性糖尿病外，最广泛复制和验证的方法还确定了四个亚组，指定为严重的胰岛素缺乏糖尿病、严重的胰岛素抵抗糖尿病、轻度肥胖相关糖尿病和轻度年龄相关糖尿病亚组。这些亚组表现出不同的临床特征、疾病进展以及合并症和并发症的发生模式，严重的胰岛素抵抗型糖尿病患者患心血管、肾脏和脂肪肝疾病的风险最高。虽然有人建议这些亚组中的人将从分层治疗中受益，但需要 RCT 来评估任何重新分类工作的临床效用。几个方法和实际问题也需要进一步研究：用于定义亚组和得出糖尿病护理建议的统计方法；子群随时间的稳定性；用于重新分类的最佳数据集（例如表型与基因型）；调查结果的跨种族普遍性；以及在临床常规护理中的适用性。尽管有这些悬而未决的问题，

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